Conduct, Bipolar Disorder Often Comorbid with ADHD

By Splete, Heidi | Clinical Psychiatry News, July 2005 | Go to article overview

Conduct, Bipolar Disorder Often Comorbid with ADHD


Splete, Heidi, Clinical Psychiatry News


HOUSTON -- "When I am asked whether I think [attention-deficit hyperactivity disorder] is overdiagnosed, I say that kids are underfoot now more than they used to be," Saundra Gilfillan, D.O., said at the annual meeting of the American Society for Adolescent Psychiatry.

"Did we miss ADHD before? No, the hyperactive kids wore themselves out," said Dr. Gilfillan, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas, which cosponsored the meeting.

Comorbidities are common with ADHD: As many as 80% of children and adolescents with ADHD meet criteria for a related category disorder, particularly conduct disorder, oppositional defiant disorder, and bipolar disorder. When evaluating a child or adolescent for ADHD, it is important to consider other conditions as well.

When Dr. Gilfillan assesses children and adolescents for ADHD, with or without comorbidities, she starts by asking parents about the child's behavior as an infant.

Hyperactive children were often very active in utero and active as infants; they didn't sleep well and were distracted when eating, she said. In addition, children with ADHD often skipped the crawling stage or spent very little time crawling. Dr. Gilfillan also asks whether the child or adolescent is invited to birthday parties.

"It's a very big developmental thing on the social side," and parents who recognize a "hyper," aggressive child may not want the child in their house, she noted. She also asks about emergency department visits and car accidents.

"I like to look at report cards, to see what teachers wrote about behavior," she said. Another question is who babysits. "If the grandmother won't babysit the child, then that's a problem."

People do not truly outgrow ADHD; the symptoms simply evolve. Motor hyperactivity in childhood evolves into internal feelings of restlessness in adolescence and adulthood. They often have problems in classes where they have to sit or take notes, she said.

Children with ADHD who do not have comorbid conditions generally exhibit less severe symptoms. Their carelessness and inattention may lead to destructiveness and misbehavior, but it appears to be unintentional. Children with ADHD who also have conduct disorder, oppositional defiant disorder, and bipolar disorder are more likely to have social problems, to require hospitalization, and to develop other problems such as depression and anxiety. Here are more specific observations on the comorbidities:

* Conduct disorder. "I call these the thugs and 'thugettes,'" Dr. Gilfillan said. These children or teens have no respect for societal norms--they genuinely do not care about the rights of others. …

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