ADHD Comorbidity

The only “one size fits all ” intervention for ADHD.

“I know all about ADHD, my nephew has ADHD, this kid is just “defiant”.

” When I was a kid, I had focusing problems but I just played sports and everything turned out fine”.

Grrrr… Good for you and your nephew. The truth is , “If you’ve met one child with ADHD, then you’ve met one child with ADHD”. *

ADHD is a highly comorbid condition. Approximately 75% of children who are diagnosed with ADHD have at least one other disorder or learning disability that causes significant problems in day-to-day occupational performance.

Frequent school age comorbidities include learning disabilities, oppositional defiant disorder, anxiety, autism , and tic disorders. In school-age children, ADHD is very closely associated with language and communication difficulties , motor coordination problems and sensory processing difficulties.

The results of Lang et al 2011 study of 5028 children with ADHD in the US are shown below to illustrate.

The comorbidity curveball is in addition to the natural shift of symptom manifestation across different developmental stages of a child’s life and the extreme contextual sensitivity of ADHD symptoms.

I will say it again. “If you’ve met one child with ADHD, then you’ve met one child with ADHD”. *

The dynamic occupational performance deficits caused by ADHD and its possible comorbidities, age/stage presentation and contextual dependence leaves teachers and school admin with no singular effective intervention for “ADHD”.

It is critical to address the needs of the individual student in the exact performance context and to look beyond the diagnostic label and your own past and present experiences of others with ADHD.

Students with ADHD need continuous highly individualized support tailored to different stages of development to enable participation in the school setting and remove barriers caused by the dynamic ADHD presentation.

We must address the student within the realm of their current context ,life situations, and consider the presence and prevention of comorbidities that may introduce additional challenges. 

“Without intervention, children with ADHD are more likely to struggle academically and are at higher risk for developing comorbid depression, oppositional defiant disorder, and/or conduct disorder. “Reference Biederman, Monuteaux, Spencer, Wilens and Faraone

Best practice and the only “one size fits all” intervention for school based occupational therapy practitioners is ongoing collaborative problem solving with caregiver education (teacher and parent), caregiver competency building and strategic scaffolding of contextual supports in the natural environment.

“Teachers do well when they can”. Teachers need so much more than another “This is ADHD” professional development course or long winded list of possible teaching strategies .

They need TRUE ongoing inter-professional collaborative problem solving with the school based occupational therapist to dynamically support students with ADHD in the least restrictive classroom environment.

We have the tools, the training and the background to help the teachers. Imagine if just one of the child’s pull out sessions was direct to the teacher? Once a month, once a week? The progress would be 5 fold.

School based OT’s need to start the conversation at your schools, educate the team on what SBOT actually is and advocate for collaborative problem solving TIME with your students teachers.

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*Adapted from Stephen Shores quote

Graphic from Tremmery, Sabine & Buitelaar, Jan & Steyaert, Jean & Molenberghs, Geert & Feron, Frans & Kalff, Ariane & Hurks, Petra & Hendriksen, Jos & Vles, Johan & Jolles, Jelle. (2007). The use of health care services and psychotropic medication in a community sample of 9-year-old schoolchildren with ADHD. European child & adolescent psychiatry. 16. 327-36. 10.1007/s00787-007-0604-5.