Running head: AN INTEGRATIVE REVIEW 1

Childhood ADHD and Risk of Mental Health Disorders

Jessie Holt

Bon Secours Memorial College of Nursing

NUR 4122 Nursing Research

4/25/17

I pledge
AN INTEGRATIVE REVIEW 2

Abstract

The purpose of this integrative review is to evaluate literature regarding the risk of school-aged

children with ADHD having an additional psychiatric disorder. ADHD is one of the most

commonly diagnosed psychiatric and neurodevelopmental disorders and has been shown to lead

to poor functional outcomes in children and adolescents. Databases including EBSCO Discovery

Services and PubMed were used to located and narrow down research articles. The literature

searches produced two hundred and twenty-six articles, where five met the specific research

criteria established for this topic. The results of these five articles overwhelmingly portray that

school-aged children diagnosed with ADHD are at an increased risk for having an additional

mental health disorder as compared to individuals without ADHD. There are limitations to this

review due to the inherent lack of experience and knowledge of the researcher in writing an

integrative review. Early screening, detection, and interventions for children with ADHD will

aim to help prevent poor functional outcomes and the incidence of an additional psychiatric

disorder. Additional research should focus on finding the best methods for undertaking early

screening, detection, and interventions to help prevent the development of an additional

psychiatric disorder.
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Childhood ADHD and Risk for Additional Psychiatric Disorders

The purpose of this integrative review is to assimilate peer-reviewed research and

literature regarding whether or not school-aged children diagnosed with Attention-Deficit

Hyperactivity Disorder (ADHD) are at an increased risk for additional mental health disorders in

comparison to children without ADHD. ADHD has an estimated prevalence of about three to

five percent worldwide, and is one of the most commonly diagnosed cognitive and behavioral

disorders in children. Previous literature shows an inconsistency in co-morbidity rates between

ADHD and psychiatric disorders, where research to distinguish a connection between the two

could have a drastic effect on screening, prevention, and treatment strategies for ADHD.

Additionally, it has been established that children with ADHD and co-morbid psychiatric

disorders have poorer outcomes with significantly greater social, emotional, and psychological

difficulties than those with ADHD alone (Yoshimasu et al., 2012). Therefore, the proposed PICO

question by this researcher is as follows: Are school-aged children diagnosed with ADHD at an

increased risk for additional mental health disorders as compared to school-aged children without

ADHD?

Research Design, Search Methods, and Search Outcomes

This integrative review focuses on five research articles. Two databases, EBSCO

Discovery Services and PubMed, were utilized to search for articles that fit specific criteria

proposed by the researcher. Key terms used in these searches included, ADHD, co-morbidity,

psychiatric disorder, and school-age children. EBSCO Discovery Services yielded 125

articles and PubMed yielded 101 articles.

In order to acquire recent articles, the search was limited to articles from 2012-2017. To

additionally narrow down the search, filters were applied to locate peer-reviewed articles written
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in English that were published within academic journals in full text. After significantly limiting

the literature search criteria, the researcher located and examined five articles that met all set

qualifications. Included in this review are five quantitative studies that directly relate to the PICO

question at hand: are school-aged children diagnosed with ADHD at an increased risk for

additional mental health disorders as compared to school-aged children without ADHD?

Findings/Results

The results and findings of the five research articles clearly identify a correlation between

ADHD and co-morbid psychiatric disorders (Amiri et al., 2013; Cuffe et al., 2015; Jacob,

Srinath, Girimaji, Seshadri, & Sagar, 2016; Ottosen, Peterson, Larsen, & Dalsgaard, 2016;

Yoshimasu et al., 2012). A summary of research articles is located in Appendix 1. This review is

structured based on the following categories: psychiatric disorders based upon gender and the

importance of early screening and interventions.

Psychiatric Disorders Based Upon Gender

There was a consensus among three quantitative research studies that further

distinguished the risk of developing a specific type of psychiatric disorder depending on the

gender of the school-age child (Amiri et al., 2013; Ottosen et al., 2016; Yoshimasu et al., 2012).

The descriptive analytical quantitative study by Amiri et al. (2013) was performed to determine

the lifetime prevalence of psychiatric disorders concomitant with ADHD among school-age

children. Four schools within an Iranian school district were randomly selected to be participants

in this study. Teachers assessed the ADHD symptoms of their students and interviewed these

screened students using child and adolescent psychiatrists as according to the DSM-IV-TR

diagnostic criteria. Children and their parents underwent the K-SADS-PL semi-structured

diagnostic interview in order to diagnose psychiatric co-morbidities. The study found that
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ADHD was more common among boys as compared to girls, with the most common psychiatric

co-morbidity being Oppositional Defiant Disorder, (ODD), with a prevalence rate of 29.4%.

Risks of ODD co-morbidity are higher among boys compared to girls in both general and clinical

samples. Overall, 62.5% of the primary school sample children with ADHD had a psychiatric co-

morbidity (Amiri et al., 2013).

The quantitative cohort study by Ottosen et al. (2016) explored the gender differences in

association between ADHD and substance use disorders, (SUD), and explored the impact of co-

morbid psychiatric conditions. They merged data on diagnoses of ADHD, co-morbidity, and

SUD through using the Danish Civil Registration System and the Danish National Patient Ratio

to identify the sample group. The International Classification of Diseases-Tenth Revision (ICD-

10) was used to identify diagnoses of ADHD within their Danish birth cohort. Data was analyzed

by collapsing SUD outcomes according to the three most prevalent types of substances into three

groups: alcohol, cannabis, and other illicit substances. They found that ADHD in childhood is

associated with an increased risk of developing a substance use disorder (SUD) in adolescence.

ADHD significantly increased the risk of several types of SUD in both boys and girls, in

comparison to those without ADHD. Girls with ADHD were more likely to develop a cannabis

or alcohol use disorder whereas males were at the highest risk for abuse of other illicit

substances, in comparison to boy and girls without ADHD (Ottosen et al., 2016).

The experimental quantitative study by Yoshimasu et al. (2012) used a retrospective

population-based epidemiological birth cohort to study the incidence of ADHD. The study also

aimed to identify co-morbid psychiatric disorders among recognized ADHD incident cases, as

well as differences in gender and ADHD co-morbidity. Three hundred and seventy-nine ADHD

incident cases were identified and followed until age nineteen. Two controls were selected from
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the birth cohort for each ADHD incident case, matched based upon gender and age. The DSM-

IV provided a measurement tool to define ADHD diagnoses, and to provide information on co-

morbidities using a computerized medical index retrieval system. They found that children with

ADHD are at a significantly increased risk for a wide range of psychiatric disorders. In addition,

the strength of the association between ADHD and being at risk for a psychiatric disorder was

similar for boys and girls, but differed on the type of psychiatric disorder. Among children with

ADHD, boys were more likely to develop externalizing-only co-morbid psychiatric conditions

such as ODD and CD. On the other hand, girls with ADHD were significantly more likely to

have internalizing-only co-morbidities such as anxiety and depression. The same pattern was

evident when comparing non-ADHD girls and boys. The strongest association between ADHD

and the broad range of psychiatric disorders was with ODD/CD.

Importance of Early Screening and Interventions

Three of the five research studies expressed the importance of early screening for ADHD

as well as early interventions (Cuffe et al., 2015; Jacob et al., 2016; Yoshimasu et al., 2012).

Jacob et al. (2016) looked at why ADHD and psychiatric co-morbidity is so important. Phone

interviews were used to collect behavioral information from teachers regarding their students

after consent from the parents were given. Diagnostic interviews for participants were then used

to confirm an ADHD diagnosis and to diagnose co-morbid psychiatric conditions. Jacob et al.

(2016) found that all except one participant had a psychiatric co-morbidity, where ODD was the

most common psychiatric condition and even impacted the severity of ADHD symptoms. A

significant number of children had academic problems, 87.5%, which can help identify methods

for helpful interventions to aid these children. This highlights the importance of early screening

and evaluating children with ADHD for co-morbid conditions and ensuring they are managed
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appropriately. In addressing both the primary disorder as well as an impending co-morbidity, it is

hoped that the negative functional outcomes faced by many with ADHD can be avoided.

Cuffe et al. (2015) investigated the prevalence and overall impact of co-morbid

psychiatric disorders in ADHD school-aged children. A two-phase design was used to identify

ADHD in school-aged children. Teachers and parents were both screened in South Carolina and

Oklahoma, where high-screen children then received diagnostic interviews. They found that

more than half of the school-aged children with ADHD also had a co-morbid psychiatric

disorder. Additionally, they found that having ADHD significantly increased the risk of poor

functional outcomes across multiple domains. The research findings suggest that children with

ADHD may benefit from classroom accommodations, interventions, and additional support to

improve their academic performance. Early screening and interventions can be crucial to prevent

the negative functional outcomes of developing ODD or CD. Children with ADHD and co-

morbid ODD or CD can also be a part of interventions to prevent their involvement in the legal

system or dropping out from school. Overall, these findings should be used to inform

intervention and prevention efforts for all children within the USA with a current ADHD

diagnosis.

Yoshimasu et al. (2012) evaluated the link between ADHD and other co-morbid mental

health disorders and found that children diagnosed with ADHD between the ages of six and

twelve were at a significantly increased risk for a range of mental health disorders. They found

that sixty-two percent of the birth cohort with an ADHD diagnosis developed one or more

psychiatric co-morbidities, as opposed to the nineteen percent without an ADHD diagnosis that

developed a psychiatric co-morbidity. They further highlight the importance of remaining alert to

the likely incidence of internalizing and externalizing psychiatric disorders for both boys and
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girls (Yoshimasu et al., 2012). Due to the results, screening and prevention should become an

essential aspect of a comprehensive clinical assessment and care of a child with ADHD.

Discussion/Implications

Amiri et al., (2013), Jacob et al., (2016), & Yoshimasu et al., (2012) demonstrated that

two-thirds of children diagnosed with ADHD had at least one additional or co-morbid mental

health disorder. This indicates that the frequency of additional psychiatric co-morbidities in

school-age children with ADHD is high, and may affect disease course and treatment. Ottosen et

al. (2016) found that ADHD was associated in both boys and girls with an increased risk of

alcohol, cannabis, and other illicit substance abuse. An important clinical implication of these

results is for providers to offer early interventions to help prevent the occurrence or development

of SUDs and additional psychiatric disorders in school-aged boys and girls. Cuffe et al. (2015)

showed that children with ADHD that developed a co-morbid anxiety or mood disorder were

more likely than children without ADHD to have below average academic performance.

These findings directly support the researched PICO question, and express that school-

age children diagnosed with ADHD are at an increased risk for additional psychiatric disorders

when compared to school-aged children without ADHD. This review maintains the necessity of

all medical professionals to become aware that children and adolescents are at a considerable risk

for an additional mental health disorder and may require early interventions. Regular screening

should be incorporated into the health assessment of a child and adolescent with ADHD, and

hopefully will reduce the incidence of adverse academic or social outcomes commonly

experienced and reported by this age group. Inclusive screening to evaluate and manage co-

morbid psychiatric disorders will hopefully lessen the burden of additional disease on the

adolescent, as well as to their family and society. Clinicians, family, and friends should all be
AN INTEGRATIVE REVIEW 9

knowledgeable of the potential co-occurrence of both externalizing and internalizing mental

health disorders for both boys and girls. Awareness among healthcare providers and early

screening will help to reduce the various adverse emotional and social outcomes reported.

Limitations

There are multiple limitations acknowledged by the researcher that influenced this

integrative review. The integrative review was conducted solely by the researcher as a final

course assignment. This paper is the researchers first effort at writing an integrative review, and

an intrinsic lack of professional knowledge may affect the review. The researcher is a full-time

undergraduate nursing student with a restricted amount of available time to devote to the review

due to both her class and working schedule. The assignment criteria included researching five

articles within the last five years.

Conclusion

The findings and results of the five reviewed studies overwhelmingly indicate that

children with ADHD are at an increased risk for additional psychiatric disorders (Amiri et al.,

2013; Cuffe et al., 2015; Jacob et al., 2016; Ottosen et al., 2016; Yoshimasu et al., 2012). These

results express a strong connection between a childhood ADHD diagnosis and a wide range of

additional mental health disorders. Four studies demonstrated that of all the psychiatric

associations, the connection between ADHD and ODD was the strongest (Amiri et al., 2013;

Cuffe et al., 2015; Jacob et al., 2016; Yoshimasu et al., 2012). Ottosen et al., (2016) state that

children diagnosed with ADHD had up to a 2.6 time increase in their risk of substance use,

abuse, and dependence in comparison to those without ADHD. The overwhelming results by all

five studies support the PICO question by showing development of an additional psychiatric

disorder in children diagnosed with ADHD in comparison to children without ADHD.

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References

Amiri, S., Shafiee-Kandajani, A.R., Fakhari, A., Abdi, S., Golmirazaei, J., Rafi, Z.A.,

Safikhanlo, S. (2013). Psychiatric comorbidities in ADHD children: an Iranian study

among primary school students. Archives of Iranian Medicine, 16(9), 513-517. Retrieved

from: https://www.ncbi.nlm.nih.gov/pubmed/23981153

Cuffe, S.P., Visser, S.N., Holbrook, J.R., Danielson, M.L., Geryk, L.L., Wolraich, M.L.,

McKeown, R.E. (2015). ADHD and psychiatric comorbidity: functional outcomes in a

school-based sample of children. Journal of Attention Disorders, 1-10. doi:

10.1177/1087054715613437

Jacob, P., Srinath, S., Girimaji, S., Seshadri, S., Sagar, J.V. (2016). Co-morbidity in attention-

deficit hyperactivity disorder: a clinical study from India. East Asian Arch Psychiatry

26(5), 148-153. Retrieved from: https://www.ncbi.nlm.nih.gov/labs/articles/28053283/

Ottosen, C. Peterson, L., Larsen, J.T., Dalsgaard, S. (2016). Gender differences in associations

between attention deficit/hyperactivity disorder and substance use disorder. Journal of

the American Academy of Child and Adolescent Psychiatry 55(3), 227-234. Retrieved

from: https://www.ncbi.nlm.nih.gov/pubmed/26903256

Yosimasu, K., Barbaresi, W. J., Colligan, R.C., Voigt, R.G., Killian, J.M., Weaver, A.L.,

Katusic, S.K. (2012). Childhood ADHD is strongly associated with a broad range of

psychiatric disorders during adolescence: a population-based birth cohort study. The

Journal of Child Psychology and Psychiatry, 53(10), 1036-1043. doi: 10.1111/j.1469-

7610.2012.02567.x
 Running head: ADHD AND RISK OF MENTAL HEALTH DISORDERS 11

Nursing 4122: Nursing Research

Appendix 1: Table of Quantitative Evidence
First Author (Year) and Amiri (2013) Medical Doctor at the Clinical Psychiatry Research Center at the Tabriz University of Medical Sciences, Iran
Qualifications
Background / Problem Study was done to determine the lifetime prevalence of psychiatric disorders concomitant with ADHD among primary school
Statement students
Previous research showed that more than 50% of ADHD patients suffer from psychiatric co-morbidities
Conceptual/theoretical Descriptive analytical quantitative study
framework
Design/Method/ Cluster sampling method done in two stages
Philosophical Philosophical underpinnings were not discussed
Underpinnings
Sample/Setting/Ethical 1,658 subjects aged between 7-12 years
Considerations Three random male and female schools were selected in each Iranian school district, and then two classes from each school
were chosen and all the included students were studied
Does not comment on ethical approval
Major Variables Performed to determine the lifetime prevalence of psychiatric disorders concomitant with ADHD among school-aged children
Studied in Iran
Measurement Tool/Data Teachers assessed the ADHD symptoms by completing Conners Teaching Rating Scale and the ADHD rating scale
Collection Method The screened students were interviewed by a child and adolescent psychiatrist according to the DSM-IV-TR diagnostic criteria
Both children and their parents underwent K-SADS-PL semi-structured diagnostic interview for diagnosis of psychiatric co-
morbidities
Data Analysis Data analyzed by SPSS software version 13
Descriptive statistics including frequency, %, mean, and standard deviation were used to describe epidemiologic characteristics
and the prevalence of diseases
Chi square and Fisher exact tests were applied to compare the frequencies, p-values less than 0.05 were considered significant
Findings/Discussion ADHD was more common among boys compared with girls
100 out of 160 ADHD patients had a psychiatric co-morbidity, with 1 in 26 children, 2 in 36 subjects, and three or four co-
morbid disorders in 38 students
Most common psychiatric co-morbidities included ODD and anxiety
Worth to Appraisal 62.5% of primary school students with ADHD had psychiatric co-morbidity
The results indicated that the frequency of other psychiatric co-morbidities in school-age children with ADHD is high and may
affect disease course and treatment
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First Author Cuffe (2015) Medical Doctor specializing in Child and Adolescent Psychiatry at The University of Florida, Jacksonville
(Year)
Qualifications
Background A 2007 National Survey of Childrens Health found that 33% of children aged 6-17 with ADHD had one other co-morbidity, 16%
Problem had two, and 18% had three or more co-morbidities.
Statement The functional impact of co-morbidities has been found to be extremely significant and is associated with poorer outcomes in
academic achievement, grade retention, delinquency, social competence, and parent-child communication
Conceptual/theore Not discussed
tical Framework
Design/Method/ Quantitative community-based epidemiological multi-site study
Philosophical Used a two-phase design to identify ADHD in elementary school-age children
Underpinnings Teachers and parents briefly completed ADHD screening instruments
Method was described in detail within another research study,
Sample/Setting/ These screening instruments were done within one school district in South Carolina with 4,604 participants, and within five schools in
Ethical Oklahoma, including 12,626 participants from 2003-2006.
Considerations The children ranged from kindergarten age to fifth grade.
Major Variables Whether children with ADHD will have higher rates of co-morbid psychiatric disorders, compared to children without ADHD
Studied Evaluating whether children with ADHD and co-morbid disorders will have more strained relationships with peer, parents, poorer
school outcomes, and lower self-reported ratings of emotional and school functioning than among children with ADHD alone or
children without ADHD. Determining whether children with ADHD and co-morbid conduct and ODD will have higher parent-
reported rates of adverse behavior such as trouble with the police, school expulsions, or suspensions than children with ADHD alone
or children without ADHD
Measurement Data was obtained by a diagnostic interview about 1 year after screening and included the Diagnostic Interview Schedule for
Tool/ Data Children, version IV reflecting diagnostic criteria for mental disorders as described in the DSM IV
Collection Method Demographic data was collected from parents using a separate questionnaire
The functional impact of ADHD and co-morbidities was estimated for several academic and social outcomes, where teachers reported
the academic performance of the participants
Data Analysis All statistical analyses were done using SAS
Findings More than half of the elementary aged children with ADHD had a co-morbid psychiatric disorder. Children with ADHD and co-
Discussion morbid anxiety/mood disorder were significantly more likely than children with ADHD have below average academic performance
Worth to CD and ODD were the most prevalent co-morbid disorders among children with and without ADHD, followed by anxiety disorders
Appraisal and mood disorders. A child with ADHD is significantly more likely to have another psychiatric disorder. These findings can be used
to inform prevention and intervention efforts for the estimated 5.1 million children in the USA diagnosed with ADHD
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First Author Jacob (2016) Physician with the Department of Child and Adolescent Psychiatry with the National Institute of Mental Health and
(Year) and Neuro Sciences located in Bangalore, India.
Qualifications
Background / ADHD is a widespread but complex neurodevelopmental disorder with childhood or adolescent onset with varying incidences of co-
Problem morbidity
Statement To assess the prevalence of co-morbidity in children diagnosed with ADHD at a tertiary care child and adolescent psychiatry center
Conceptual/theore Determined to answer the question, why is co-morbidty with ADHD so important?
tical framework
Design/Method/ Observational and prospective quantitative study
Philosophical Included using the Mini-International Neuropsychiatric Interview for Children and Adolescents, the ADHD Ration Scale IV,
Underpinnings Childrens Global Assessment scale, Clinical Global Impression scale, Vineland Social Maturity Scale, and the Childhood Autism
Rating Scale
Sample/Setting/ A total of 63 children diagnosed with ADHD were assessed comprehensively for neurodevelopmental and psychiatric co-morbidities
Ethical in a tertiary care center in Bangladore, India.
Considerations The Institute Ethics Committee approved the study
Major Variables Birth and developmental history including prenatal factors, perinatal, and postnatal factors
Studied Medical co-morbidity, neurodevelopmental co-morbidity, and psychiatric co-morbidity
Academic issues due to mental health disorders
Measurement The socio-demographic and clinical profiles were recorded as per a pre-specified format followed by the Department of Child and
Tool/Data Adolescent Psychiatry, NIMHANS
Collection Method Phone interviews were used to collect behavioral information from teachers regarding their students, after consent was given
Diagnostic interviews for participants were used to confirm the diagnosis of ADHD and to diagnose psychiatric co-morbidities
Data Analysis Data was tabulated and analyzed using the Statistical Package for the Social Sciences version 21.0

Findings/Discussio All except 1 participant had a neurodevelopmental and/or psychiatric co-morbidity, and 66.7% had both a psychiatric and
n neurodevelopmental disorder. ODD was the most common psychiatric co-morbidity.
Co-morbidity is present at an extremely high incidence in children diagnosed with ADHD.
Worth to Highlights the importance of screening and evaluating for co-morbid conditions and ensuring they are managed appropriately
Appraisal Co-morbidity with ADHD seems to be the rule rather than the exception
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First Author (Year) Ottosen (2016) holds a Bachelors of Science and works with the National Centre for Register-based Research, Aarhus
and Qualifications University; Aarhus, Denmark
Background / Problem Childhood ADHD is commonly associated with an increased risk of developing a substance use disorder (SUD) in adolescence
Statement Aims to examine the gender differences in association between ADHD and substance use disorders, and to explore the impact of
co-morbid psychiatric conditions
Conceptual/theoretical Not discussed
framework
Design/Method/ Birth cohort quantitative study
Philosophical Used previous records to merge birth data and diagnoses of ADHD, co-morbidities and SUD
Underpinnings
Sample/Setting/Ethical Used the Danish Civil Registration System to identify all children born in Denmark to Danish parents between 1990 and 2003
Considerations 713,393 children included in the sample size
Ethical considerations were not mentioned
Major Variables ADHD and gender differences in SUD
Studied Effect of co-morbid conditions on risk of SUD
Measurement ICD-10 used to identify ADHD diagnoses within the cohort
Tool/Data Collection
Data Analysis Incidence rates of SUD were calculated and Cox regression was used to estimate confidence intervals and hazard ratios
4 adjustment models were applied in the overall analyses

Findings/Discussion ADHD increased the risk of all SUD outcomes
Individuals with ADHD and without other co-morbidities were also at increased risk
Within the study cohort, they found 19,645 individuals with ADHD
Worth to Appraisal The study found that ADHD in childhood is associated with an increased risk of developing a substance use disorder (SUD) in
adolescence.
ADHD significantly increased the risk of several types of SUD in both boys and girls, in comparison to those without ADHD.
Girls with ADHD were more likely to develop a cannabis or alcohol use disorder whereas males were at the highest risk for
abuse of other illicit substances, in comparison to boy and girls without ADHD
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First Author (Year) Yoshimasu (2012) Medical Doctor and PhD. Working at Mayo Clinic within the pediatric specialty
Qualifications
Background ADHD is commonly reported as being accompanied by psychiatric disorders, but co-morbidity rates between ADHD and mental health
Problem Statement disorders are inconsistent and not well understood
Conceptual/theoreti Researchers aimed to evaluate the associations between ADHD and co-morbid psychiatric disorders
cal Framework
Design/Method/ Quantitative Experimental, Retrospective population-based epidemiological birth cohort study
Philosophical Contractual permission was granted to the researchers in order to access the cohorts educational and medical records in Rochester, MN
Underpinnings Records were searched for behavioral problems or educational concerns about a childs learning as documented by parents, social workers,
physicians, and school psychologists and/or school nurses
Sample/Setting/Ethi A total of 5,718 children participated in the cohort, and were born to mothers residing within Rochester, MN between January 1, 1976 and
cal Considerations December 31, 1982. From the 5,718 total children included, 1,961 were found to have varying concerns within their records and were
labeled as a research-identified ADHD incident case
Of the entire sample, 379 ADHD incident cases were identified and followed from their birth to age 19
For each ADHD incident case, two controls were selected from the birth cohort, matched based on gender and age
The Institutional Review Boards of Mayo Clinic and Olmsted Medical Center ethically approved this study
Major Variables ADHD incidence within a population based birth cohort study. Identifying co-morbid psychiatric disorders among recognized ADHD
Studied incident cases and controls. Differences in gender and ADHD co-morbidity
Measurement Tool / DSM IV provided a measurement tool to define ADHD diagnoses plus information regarding co-morbidities using a computerized medical
Data Collection index retrieval system. Participants were classified into 2 categories based upon their co-morbidity: internalizing or externalizing disorders
Data Analysis Chi-squared and Fishers exact test for categorical variables. Kaplan-Meier method was used to calculate the incidence probability that a
cohort would be diagnosed with one of the 10 most common psychiatric co-morbidities, Cox proportional hazards model used to evaluate the
association between ADHD and the time to the diagnosis of an additional psychiatric disorder. The several links were summarized through
estimating a hazards ratio and confidence interval. To evaluate the associations between ADHD, each psychiatric disorder, and differences in
gender, a multinomial logistic regression analysis was used, P-value was used to determine statistical significance
Findings The results showed statistical significance and a myriad of connections. ADHD is significantly associated with a wide range of psychiatric
Discussion disorders, including CDD/OD, mood, anxiety, tic, personality, and substance abuse disorders
62% of the cohort with ADHD developed one or more psychiatric co-morbidity by age 19, as opposed to the 19% whom developed a co-
morbidity within the control group without ADHD. The connection between ADHD and psychiatric disorders was found to be similar for
both boys and girls, but differed on the type. Girls were more likely to have internalizing-only co-morbidities such as mood and anxiety
disorders, whereas boys were likely to have externalizing-only psychiatric disorders
Worth to Appraisal Children with ADHD are at a significantly increased risk for a wide range of psychiatric disorders. In addition to treating ADHD, healthcare
providers should utilize early detection and treatment, as well as screen for additional mental health disorders on a regular basis
Screening for evaluating and managing such co-morbid conditions will reduce the likelihood of the adverse social and emotional outcomes
reported within the literature
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