• One

disorder is a risk factor for developmental of the other;

• The disorders share the same related risk factors; or
• There is a common underlying symptomatic basis for one or more of the behaviours in common.

Table 2.1 Prevalence of Comorbidities

Psychiatric comorbidities prevalence: + 1-10% ++ 11-30% +++ >31% ? controversial/unknown

CHILD (6-12) ADOLESCENT (13-17) ADULTS (18+)

ANXIETY ++ ++ +++
DEPRESSION + ++ +++
LEARNING DISABILITIES +++ +++ +++
OPPOSITIONAL DEFIANT DISORDER +++ ++ +
CONDUCT DISORDER ++ ++ ++ (Antisocial PD)
BIPOLAR + (?) + ++
SUBSTANCE USE + ++ +++
AUTISM SPECTRUM DISORDER ++ ++ ++ (?)
TIC DISORDERS ++ ++ +
DMDD ? ? ?
BORDERLINE PERSONALITY DISORDER ? +++
OBSESSIVE COMPULSIVE DISORDER + + ++

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OVERLAPPING SYMPTOMS
DIFFERENTIAL DISTINCT CHARACTERISTICS
WITH ADHD
- Refuses to comply with rules
- Loses temper
- Deliberately annoys others
Oppositional Defiant - Angry, resentful
- Blames others for their own mistakes
Disorder - Touchy, easily annoyed
- Spiteful, vindictive
- Argumentative

- Impulsively starts fights as a reaction

to provocation
- Instigates fights and may use weapons
- May be rough with animals/people
- Takes pleasure in cruelty to animals
due to lack of self- control
and/or people
- Forgets curfew
- Disobeys curfew and runs away to
- Sets fire without considering
engage in preferred activities without
Conduct Disorder consequences
regard to consequences
- Steals impulsively
- Sets fires with vengeance
- Lies impulsively to avoid
- Steals with confrontation (planned)
consequences
- Lies to manipulate others and obtain gain
- Breaks things accidently or
- Vandalizes
impulsively

- May enter into conflict with the law

- Fails to conform to social norms with
due to impulsive behavior (e.g.
respect to lawful behaviors as indicated
speeding)
by repeatedly performing acts that are
- Lying impulsively to avoid
grounds for arrest
consequences
Antisocial Personality - Deceitful, as indicated by repeated lying,
- Is impulsive or fails to plan
Disorder use of aliases, or conning others for
- Can be irritable and have interpersonal
personal profit or pleasure
conflict (losing control)
- Repeated failure to sustain consistent
- May put self and others at risk due to
work behavior or honor financial
impulsivity and lack of forethought
obligations

- Inattentive symptoms independent of
emotional state
- Fidgetiness independent of emotional
state
- Social disinhibition
Anxiety Disorder - Initial insomnia because of a difficulty
to ‘turn their thoughts off’
- No subjective physical symptoms
- Transient and realistic worries related
to prior and actual functional
impairment (e.g. performance anxiety)
- Loss of motivation, demoralization
Major Depressive
- Problems concentrating
Disorder
- Being restless or irritable
- Initial insomnia, sleep disorders
- Chronic restlessness
- Impulsive sexual encounters
Bipolar Disorder
- Chronic course
- Chronic distractibility and/or
impulsivity
- Irritable mood episodes (explosive
outburst)
Disruptive Mood
- Psychomotor agitation
Dysregulation
- Chronic course
- Young age of onset
- Usually 6-7 years old and older
- Language Not delayed No echolalia
- Less eye contact as eyes frequently
Autism Spectrum shift focus
Disorder - More social in play
- Ostracized for impulsive behavior,
inattentive to other’s states of mind,
drawn to impulsive peers
- Hyperactivity, “always on the go”
- Can be Irritability and aggressiveness, as
indicated by repeated physical fights
(taking control)
- Reckless disregard and lack of care for
safety of self or others; lacks remorse
(indifferent to or rationalizing having
hurt, mistreated or stolen from another)
- Inattentive symptoms when anxious
- Fidgetiness while anxious
- Social inhibition
- Initial insomnia because of ruminations
or other anxiety symptoms
- Physical symptoms such as pounding
heart, nausea, difficulty breathing,
tremulousness
- Persistent cognitive symptoms of intense
fear and/or worry focused on unrealistic
specific situations or thoughts
- Feeling sad or hopeless
- Feeling tired or "slowed down"
- Changes in eating and/or sleeping, neuro
vegetative symptoms
- Thoughts of death or suicide
- Episodic (while ADHD has a continuous
course since childhood)
- Decreased need for sleep
- Episodes of speediness, increased rate of
speech
- Hypersexuality
- Episodic course
- Episode-related distractibility and/or
impulsivity
- Feeling "high”, or an overly happy mood
- Grandiosity
- Inter-episode dysphoria
- Minor triggers with extreme rage attacks
- Can be as early as 2-3 years old
- Language delayed, echolalia
- Avoids eye contact
- Less social in play
- Not interested in peers, ‘parallel play’
predominant, difficulty in understanding
other’s state of mind
- Rhythmic, stereotyped movements
Common medical conditions that may have overlapping symptoms with ADHD:
- Hearing or vision Impairment
- Thyroid dysfunction
- Hypoglycemia
- Severe anemia
- Lead poisoning
- Sleep disorders
- Fetal Alcohol Spectrum Disorder (FASD)
- Neurofibromatosis

Medications that may have psychomotor side effects:

- Medication with cognitive dulling side effect (e.g. mood stabilizers).
- Medication with psychomotor activation (e.g. decongestants, beta-agonist like asthma medication).
1.3 Diagnosis and Treatment – Children

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1.4 Diagnosis and Treatment – Adolescents

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1.5 Diagnosis and Treatment – Adults

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