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Treatment Resistance in Youths With ADHD and Comorbid Conditions

Treatment Resistance in Youths With ADHD and Comorbid Conditions

Since its introduction in DSM-III in 1980, attention-deficit/ hyperactivity disorder (ADHD) has proved to be a developmental disorder with many causes and complex behavioral, cognitive, and emotional manifestations that can impair academic functioning, occupational achievement, social relationships, and self-esteem.1-3 The immediate and long-term impairments of ADHD are of great concern, particularly as more and more longitudinal studies document lifelong patterns of underachievement, sexual-reproductive and driving risks, alcohol and substance abuse, mood disorders, and reduced executive functions and coping skills.4-8

Recently, comorbid psychiatric conditions associated with ADHD have been identified as major obstacles to successful treatment and functional outcomes. The high prevalence of these conditions (Table 1) along with their negative impact on treatment outcomes has been documented in numerous studies of patients across their life spans.2,9-12 It is evident that comorbid conditions impose heavier burdens on patients with ADHD (as well as their families), and that they make it more difficult for clinicians to choose interventions that are likely to succeed with a high degree of certainty. Whereas the evidence base for multimodal treatment of ADHD "simplex" in children and adolescents is well established,13 such is not the case for patients with complex forms of the disorder.

TABLE 1
Correlations of levels of damage
  Comorbidity Prevalence (%)
Oppositional defiant disorder 35 to 50
Conduct disorder 20 to 40
Anxiety disorders 25 to 33
Major depressive disorder 15 to 20
Bipolar affective disorder 16 to 24
Tic disorders 15 to 21
Learning disorders 40 to 60*
Substance abuse disorders 37 to 55†
ADHD, attention-deficit/hyperactivity disorder.
*Using stricter criteria, this range is approximately 20% to 30%.
†Data based on adult studies.
 
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