What Is Complex ADHD? Symptoms, Diagnosis & Treatment

What is Complex ADHD?

The term “complex ADHD” reflects an evolution in our understanding of the situation, its scope, and its commonplace co-occurrence with a number of psychiatric, finding out, or different neurodevelopmental disorders.

Research confirms that spotlight deficit hyperactivity dysfunction (ADHD or ADD) regularly co-occurs with different conditions. In fact, we would possibly say this is the guideline fairly than the exception. As many as 80% of adults with ADHD have no less than one co-existing psychiatric disorder1, while approximately 60% of youngsters with ADHD have a minimum of one co-occurring condition2.

Common conditions co-occurring with ADHD include:

Apart from conveying comorbidities, the term complex ADHD also describes the situation’s heterogeneity and the number of factors that can influence its presentation. It additionally reflects ADHD’s known impact on functioning throughout many domain names of lifestyles, especially when symptoms aren't adequately treated.

The presence of co-occurring prerequisites virtually always muddles the diagnosis, treatment, and diagnosis of ADHD. ADHD and comorbidities might also influence the presentation and severity of each other, which will complicate the detection and treatment of symptoms, and impair general high quality of lifestyles. (Serious results are also associated with comorbid prerequisites. According to at least one study, mortality possibility – already increased for individuals with ADHD – increases considerably with the collection of psychiatric comorbidities3.) For all these causes, spotting ADHD’s “complexity” is of high scientific significance.

[Get This Free Resource: 9 Conditions Linked to ADHD]

Complex ADHD: Background on Terminology

The medical community has lengthy identified the prime charges of comorbid prerequisites among sufferers with ADHD. Recent updates to ADHD diagnosis and treatment pointers from skilled associations, on the other hand, additional underscore the significance of bearing in mind co-existing conditions with ADHD:

  • 2019: The American Academy of Pediatrics (AAP), in its up to date pointers for the diagnosis, evaluation, and treatment of ADHD in children and teens, recommends that clinicians trained in diagnosing comorbid stipulations initiate treatment for such prerequisites, or, if green, refer patients to experts.
  • 2020: The Society for Developmental and Behavioral Pediatrics (SDBP), to complement the AAP’s updated tips, publishes its own guidelines for assessing and treating kids and youngsters with “complex ADHD.” These guidelines suggest that skilled clinicians assess for and expand multimodal treatment plans for complex ADHD.

Understanding Complex ADHD

ADHD Comorbidities Change with Age

Although ADHD is associated with more than a few co-occurring conditions, incidence rates for comorbidities generally tend to change as an individual ages. For instance:

In Children

  • Behavior and behavior problems, like ODD and conduct disorder, happen in about half of children with ADHD2,  and aren't as commonplace in adults with ADHD.

In Adults

  • Anxiety co-occurs with grownup ADHD as regards to part the time. (Rates are decrease in kids with ADHD).4
  • Substance use dysfunction (SUD) – about 25% of young people and 50 % of adults are at risk for comorbid substance abuse with ADHD5.

[Read: ADHD Comorbidity — an Overview of Dual Diagnoses]

What Explains ADHD Comorbidity Rates?

It is believed that the co-occurrence of ADHD and comorbid conditions arises partially from shared underlying neuropsychological dysfunctions6.

ADHD’s heterogeneous presentation, in addition to the parts of the mind implicated in ADHD, might provide an explanation for why comorbidities aren't only common, but in addition wide ranging.

The prefrontal cortex (PFC), which regulates consideration, behavior, and impulsivity, options prominently in the neurological underpinnings for ADHD. But no longer all parts of the PFC – or the neural networks of the brain, for that subject – are impacted in the same way, which explains why ADHD can also be so other from individual to individual.

The variety in ADHD symptom presentation and a person’s associated options, combined with considerable duplication with signs of co-occurring conditions, has led professionals to conceptualize ADHD as a spectrum disorder1.

Complex ADHD: Diagnosis

Diagnosing complex ADHD starts with confirming that a affected person meets DSM-5 standards for ADHD on my own. Children with ADHD want to exhibit six or extra signs of inattention and/or hyperactivity and impulsivity to merit a diagnosis. Adults want simplest show off five signs. Learn more about DSM-5 symptoms and entire diagnostic standards right here: What is ADHD, and how is it diagnosed?

Conducting a radical ADHD analysis is a multi-step process that can involve the use of diagnostic score scales like the ADHD Rating Scale-5, the Vanderbilt Parents and Teacher, and the Conners Parent Rating Scale.

Even if a affected person does exhibit symptoms of ADHD, clinicians must still rule out selection explanations as part of the analysis. Changes to the affected person’s home atmosphere and cases, as an example, may just influence symptom severity and presentation.

Regardless of whether an ADHD diagnosis is established, clinicians will have to assess for comorbid stipulations. The diagnosing clinician, if skilled in doing so, can perform review for different prerequisites. Otherwise, they will have to refer the affected person to an acceptable subspecialist.

As with ADHD, clinicians might assess for comorbidities via the usage of diagnostic ranking scales like the Patient Health Questionnaire, Mood Disorder Questionnaire, and Social Responsiveness Scale-2.

While complex ADHD is in most cases outlined as ADHD with a co-occurring situation, the SDBP notes that complex ADHD is outlined by means of any of the following:

  • The presence of suspicion of: co-existing problems and complicating components; neurodevelopmental disorders; specific learning disorders; mental health issues; medical prerequisites; genetic issues; sophisticated psychosocial elements; and/or useful impairments
  • Diagnostic uncertainty on the a part of the primary care clinician
  • Inadequate response to treatment
  • The patient is more youthful than 4 or older than 12 years of age on the time of preliminary presentation of symptoms

Complex ADHD: Treatment

The accredited approach to addressing complex ADHD is to treat the comorbidities first only if they're critical, and, in all different cases, to deal with ADHD and the comorbidities concurrently. This is what makes treating complex ADHD a gentle balancing act – one condition can’t be unnoticed for the other(s). Treating ADHD might resolve and reinforce co-existing conditions. However, comorbidities may additionally require separate treatment. It is additionally true that treating only one condition can irritate others.

This up to date paradigm differs from the up to now authorized manner of treating comorbidities first, and then treating ADHD.

Treating ADHD symptoms in a person with complex ADHD should practice a multimodal way that may come with:

  • Pharmacotherapy: Stimulants are first-line medications for the treatment of ADHD, followed through non-stimulants, or from time to time a combination of each.
  • Psychotherapy (particular person, couples, and/or family) may also assist arrange co-existing conditions
  • ADHD and government function training
  • Behavioral parent training (for kids with ADHD)
  • Academic and/or place of job lodging
  • Individual and family supports
  • Healthy behavior – nutrition, sleep, and workout

Clinicians should work with sufferers to resolve distinctive spaces of impairment and problem, and tailor remedies accordingly. At the start of treatment, patients must list targets and signs to target for improvement. Over time, the patient will have to note (in all probability the usage of a scale model) how shut (or far) they have got moved with every symptom.

Complex ADHD: Next Steps

The content for this newsletter used to be derived from the ADDitude Expert Webinar Complex ADHD: The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert [podcast episode #360] with Theresa Cerulli, M.D., which was broadcast continue to exist June 23, 2021.

Thank you for studying ADDitude. To improve our challenge of providing ADHD training and reinforce, please consider subscribing. Your readership and enhance help in making our content material and outreach possible. Thank you.


1 Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: scientific implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3

2 Melissa L. Danielson, Rebecca H. Bitsko, Reem M. Ghandour, Joseph R. Holbrook, Michael D. Kogan & Stephen J. Blumberg. (Jan. 24, 2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47:2, 199-212, DOI: 10.1080/15374416.2017.1417860. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/pdf/nihms937906.pdf

3 Sun S, Kuja-Halkola R, Faraone SV, et al. (2019). Association of psychiatric comorbidity with the danger of untimely dying amongst children and adults with attention-deficit/hyperactivity dysfunction. JAMA Psychiatry, 76(11):1141–1149. doi:10.1001/jamapsychiatry.2019.1944

4 Managing ADHD in kids, teenagers, and adults with comorbid anxiety in primary care. (2007). Primary care better half to the Journal of scientific psychiatry, 9(2), 129–138.

5 Wilens, T. E., & Morrison, N. R. (2012). Substance-use problems in youngsters and adults with ADHD: center of attention on treatment. Neuropsychiatry, 2(4), 301–312. https://doi.org/10.2217/npy.12.39

6 Rommelse, N.N.J., Altink, M.E., Fliers, E.A. et al. (2009). Comorbid problems in ADHD: Degree of association, shared endophenotypes, and formation of distinct subtypes. Implications for a long term DSM . J Abnorm Child Psychol, 37, 793–804 . https://doi.org/10.1007/s10802-009-9312-6

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