Attention-Deficit/Hyperactivity Disorder (ADHD) often occurs with other disorders (called comorbidities of ADHD). About half of children with ADHD referred to clinics have behavioral disorders as well as ADHD.
The combination of ADHD with other behavioral disorders often presents extra challenges to affected individuals, educators, and healthcare providers. Therefore, it is important for doctors to screen every child with ADHD for other disorders and problems.
Difficult Peer Relationships
ADHD can have many effects on a child’s development. It can make childhood friendships, or peer relationships, very difficult. These relationships contribute to children’s immediate happiness and may be very important to their long-term development.
Children with ADHD might have difficulty in their peer relationships, for example, being rejected by peers or not having close friends. In some cases, children with peer problems may also be at higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers.
- Parents of children with a history of ADHD report almost 3 times as many peer problems as those without a history of ADHD (21.1% vs. 7.3%).1
- Parents report that children with a history of ADHD are almost 10 times as likely to have difficulties that interfere with friendships (20.6% vs. 2.0%).1
How does ADHD interfere with peer relationships?
Exactly how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.
Having ADHD does not mean a person has to have poor peer relationships.
Not everyone with ADHD has difficulty getting along with others. For those who do, many things can be done to improve the person’s relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be. Although researchers have not provided definitive answers, some things parents might consider as they help their child build and strengthen peer relationships are:
- Recognize the importance of healthy peer relationships for children. These relationships can be just as important as grades to school success.
- Maintain on-going communication with people who play important roles in your child’s life (such as teachers, school counselors, after-school activity leaders, health care providers, etc.). Keep up-dated on your child’s social development in community and school settings.
- Involve your child in activities with his or her peers. Communicate with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
- Peer programs can be helpful, particularly for older children and teenagers. Schools and communities often have such programs available. You may want to discuss the possibility of your child’s participation with program directors and your child’s care providers.
Risk of Injuries
Children and adolescents with ADHD can have more frequent and severe injuries than peers without ADHD.
Research indicates that children with ADHD are significantly more likely to:
- Be injured as pedestrians or while riding a bicycle
- Receive head injuries
- Injure more than one part of the body
- Be hospitalized for accidental poisoning
- Be admitted to intensive care units or have an injury result in disability
Further research is needed to understand what role ADHD symptoms play in the risk of injuries and other disorders that may occur with ADHD. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may engage in high-risk physical activity without thinking of the possible consequences. Teenagers with ADHD who drive may have more traffic violations and accidents and twice as likely to have their driver’s licenses suspended than drivers without ADHD.
Much of what is already known about injury prevention may be particularly useful for people with ADHD.
- Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.
- Supervise children when they are involved in high-risk activities or are in risky settings, such as when climbing or when in or around a swimming pool.
- Keep potentially harmful household products, tools, equipment and objects out of the reach of young children.
- Teens with ADHD may need to limit the amount of music listened to in the car while driving, drive without passengers and/or keep the number of passengers to a chosen few, plan trips well ahead of time, avoid alcohol and drug use and cellular phone usage.
- Parents may want to enroll their teens in driving safety courses before they get their driver’s license.
- For more injury prevention tips, visit CDC’s Injury Center.
Oppositional Defiant Disorder
Oppositional Defiant Disorder (ODD) is one of the most common disorders occurring with ADHD. ODD usually starts before age eight, but no later than early adolescence. Symptoms may occur most often with people the individual knows well, such as family members or a regular care provider. These behaviors are present beyond what are expected for the child’s age, and result in significant difficulties in school, at home, and/or with peers.
Examples of ODD behaviors include:
- Losing one’s temper a lot
- Arguing with adults or refusing to comply with adults’ rules or requests
- Often getting angry or being resentful or vindictive
- Deliberately annoying others; easily becoming annoyed with others
- Often blaming other people for one’s own mistakes or misbehavior
Recently released data from the 1997-98 National Health Interview Survey suggests roughly half of those youth 6-11 years old diagnosed with ADHD may also have a Learning Disorder (LD). The combination of attention problems caused by ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is crucial. Appropriate and timely interventions to address ADHD and LD should follow diagnosis. The nature and course of treatment for ADHD and LD may be different, and different types of providers may be involved. Working with health care professionals to determine appropriate referrals and treatment is the best way to make informed decisions for an individual dealing with ADHD and a learning problem.
Conduct Disorder (CD) is a behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. These behaviors often lead to delinquency or incarceration. Increased injuries and strained peer relationships are also common in this population. The symptoms of CD are apparent in several settings in the person’s life (e.g., at home, in the community and at school).
While CD is less common than Oppositional Defiant Disorder, it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat. A mental health professional should complete evaluations for CD where warranted, and a plan for intervention should be implemented as early as possible.
1Strine TW, Lesesne CA, Okoro CA, McGuire LC, Chapman DP, Balluz LS, Mokdad AH. Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Prev Chronic Dis. 2006 Apr;3(2):A52. Epub 2006 Mar 15.