Attention deficit hyperactivity disorder (ADHD) poses many challenges to parents in contemporary society. ADHD is a common condition that impacts an estimated 7.5% of all children and adolescents living in the United States. The onset of ADHD, however, rarely occurs on its own and is often associated with comorbid conditions. Individuals who present with one or more co-morbid condition are typically diagnosed with complex ADHD.
Complex ADHD may include the presence of conditions such as anxiety, depression, mood disorders, oppositional defiance disorder (ODD), substance use disorder (SUD), tics, severe learning disability, and intellectual disability, among others. Additionally, those with poorer responses to treatment and those who receive a diagnosis prior to the age of 4 or after the age of 12 are often considered complex ADHD cases. Current research indicates that approximately 80% of adults with diagnosed ADHD also have at least one co-morbid mental health condition. Similarly, an estimated 60% of children with ADHD suffer from one or more co-existing psychiatric condition or learning disability.
The presence of co-existing psychiatric conditions can create challenges for mental health practitioners, parents, and educators alike. The presence of multiple disorders often increases challenges associated with the diagnostic process and the practitioner must be able to distinguish between each condition and identify potential overlaps. Moreover, the overall prognosis for patients with complex ADHD is often hindered, due to the exacerbation of symptoms and the need to engage in multiple therapeutic interventions to achieve success. ADHD is already a complex disorder. The presence of co-morbid conditions is therefore important to identify, diagnose, and incorporate into treatment planning.
The treatment process, though more challenging with individuals with complex ADHD, is critical to enhancing future functioning and quality of life. New practice guidelines have been implemented in recent years to address the additional challenges associated with complex ADHD. This includes the implementation of psychosocial interventions which focus on the enhancement of social, behavioral, and academic skills, rather than a sole focus on addressing the symptoms of ADHD. The psychosocial interventions also focus on providing parental, education and school services, such as the development of special education individualized education plans (IEPs) and 504 plans.
The interventions also include intervention approaches that improve social and peer interactions that are appropriate in nature. In the classroom, these interventions attempt to enhance organizational skills and create class- room management tools that increase positive reinforcement to motivate the child to engage in academic behaviors while also implementing clear consequences when negative behaviors are displayed. Though complex ADHD increases the challenges associated with treating and managing ADHD, early and consistent interventions may increase the treatment success long-term.
Dr. Michael Clatch, Psy. D.
