Skip to main content
SpringerLink
Log in

Managing ADHD in Adolescence and Young Adulthood: Emerging Comorbidities and Tailored Treatment

  • Chapter
  • First Online:
ADHD in Adults

Part of the book series: Current Clinical Psychiatry ((CCPSY))

  • 3383 Accesses

Abstract

The prevalence of ADHD in adolescence ranges from 4 to 6%. In this age range, the disorder may manifest in difficulty fulfilling academic, personal and social responsibilities. Adolescents with ADHD often struggle to maintain routines, organize their time, be effective interpersonally, inhibit stimulus-seeking behaviors, and control their emotional reactions. Around 75% of adolescents with ADHD have at least one comorbid disorder. The most frequent are Conduct Disorder (15–30%), Substance Abuse Disorder (30–70% depending on the drug), and Mood or Anxiety Disorders (20–40%). The presence and severity of these disorders leads to under-diagnosis of ADHD, and management of ADHD may prevent or reduce morbidity associated with comorbid conditions. Collection of data by interview is sufficient to identify a diagnosis of ADHD across the lifespan. Neuropsychological evaluation may be critical to confirm learning disabilities and need for possible learning accommodation in this age group. Academic supports and accommodations may be helpful both in straightforward ADHD and in the presence of other learning disabilities. Severe outcomes associated with ADHD can occur in this age range, including illegal behavior, risky sexual activities or motor accidents. Psychopharmacology improves ADHD in adolescents and is clinically observed to reduce many but not all of these poor outcomes. It is useful to look for risk factors of worse prognosis and to anticipate persistence into adult life to design a specific support and treatment plan.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Biederman J, Milberger S, Faraone SV. Age dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816–8.

    Article  PubMed  CAS  Google Scholar 

  2. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002;111:279–89.

    Article  PubMed  Google Scholar 

  3. Biederman J, Faraone S, Millberger S, Gershon J, Tsuang MT. A prospective 4-year follow-up study of attention-deficit hyperactivity disorder. Arch Gen Psychiatr. 1996;53(5):437–46.

    Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorder. 4th ed (DSM-IV-TR). Washington: APA; 2000.

    Google Scholar 

  5. Wasserstein J. Diagnostic issues for adolescents and adults with ADHD. JCLP/In Session. 2005;61(5):535–47.

    Article  Google Scholar 

  6. Biederman J, Monuteaux MC, Doyle AE, et al. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J Consult Clin Psychol. 2004;72(5):757–66.

    Article  PubMed  Google Scholar 

  7. Taurines R, Schmit J, Renner T, Conner AC, Warnke A, Romanos M. Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord. 2010;2(4):267–89.

    Article  PubMed  Google Scholar 

  8. Klassen LJ, Katzman MA, Chokka P. Adult ADHD and its comorbidities, with a focus on bipolar disorder. J Affect Disord. 2010;124:1–8.

    Article  PubMed  Google Scholar 

  9. Soutullo CA, Escamilla I, Wozniak J, Gamazo P, Figueroa A, Biederamn J. Phenomenology of pediatric bipolar disorder in a Spanish sample: features before and at the moment of diagnosis. J Affect Disord. 2009;118(1–3):39–47.

    Article  PubMed  Google Scholar 

  10. Escamilla I, Wozniak J, Soutullo CA, Gamazo-Garrán P, Figueroa-Qintana A, Biederman J. Pediatric bipolar disorder in a Spanish sample: results after 2.6 years of follow-up. J Affect Disord. 2011;132(1–2):270–4.

    Article  PubMed  Google Scholar 

  11. Pavuluri MN, Biramher B, Naylor MW. Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2005;44(9):846–71.

    Article  PubMed  Google Scholar 

  12. Kowatch RA, Delbello MP. Pediatric bipolar disorder: emerging diagnostic and treatment approaches. Child Adolesc Psychiatr Clin N Am. 2006;15(1):73–108.

    Article  PubMed  Google Scholar 

  13. Biederman J, Petty CR, Byrne D, Wong P, Wozniak J, Faraone SV. Risk for switch from unipolar to bipolar disorder in youth with ADHD: a long term prospective controlled study. J Affect Disord. 2009;119(1–3):16–21.

    Article  PubMed  Google Scholar 

  14. Palazzo B, Moreira de Sousa C, Coutinho G, et al. Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorder. Rev Bras Psiquiatr. 2008;30(4):384–9.

    Google Scholar 

  15. Surman CB, Randall ET, Biederman J. Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case–control studies. J Clin Psychiatry. 2006;67(3):351–4.

    Article  PubMed  Google Scholar 

  16. Cortese S, Isnard P, Frelut ML, et al. Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents. Int J Obes. 2007;31(2):340–6.

    Article  CAS  Google Scholar 

  17. Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr. 2007;28(4):302–7.

    Article  PubMed  Google Scholar 

  18. Mikami AY, Hinshaw SP, Patterson KA, Lee JC. Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder. J Abnorm Psychol. 2008;117(1):225–35.

    Article  PubMed  Google Scholar 

  19. Agranat Meged AN, Deitcher C, Goldzwig G, Leibenson L, Stein M, Galili-Wisstub E. Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obeses hospitalized children. Int J Eat Disord. 2005;37(4):357–9.

    Article  PubMed  Google Scholar 

  20. Konofal E, Lecendreux M, Cortese S. Sleep and ADHD. Sleep Med. 2010;11:652–8.

    Article  PubMed  Google Scholar 

  21. Cortese S, Konofal E, Yateman N, et al. Sleep and alertness in children with attention-defict hyperactivity disorder: a systematic review of the literature. Sleep Med. 2005;29(4):504–11.

    Google Scholar 

  22. Konofal E, Cortese S, Marchand M, Mouren MC, Arnulf I, Lecendreux M. Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children. Sleep Med. 2007;8:711–5.

    Article  PubMed  Google Scholar 

  23. Sangal RB, Owens J, Allen AJ, Sutton V, Schuh K, Kelsey D. Effects of atomexetine and methylphenidate on sleep in children with ADHD. Sleep. 2006;29:1573–85.

    PubMed  Google Scholar 

  24. Van der Heijden KB, Smits MG. Van Someren Ej. Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int. 2005;22:559–70.

    Article  PubMed  Google Scholar 

  25. Bendz LM, Scates AC. Melatonin treatment for insomnia in pediatric patients with attention-deficit/hyperactivity disorder. Ann Pharmacother. 2010;44(1):185–91.

    Article  PubMed  CAS  Google Scholar 

  26. Biederman J, Petty CR, Dolan C, Hughes S, et al. The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychol Med. 2008;38:1027–36.

    PubMed  CAS  Google Scholar 

  27. Willens TE, Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry. 2011;24(4):280–5.

    Article  Google Scholar 

  28. Flory K, Milich R, Lynam DR, Leukefeld C, Clayton R. Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms in young adulthood: individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk. Psychol Addict Behav. 2003;17(2):151–8.

    Article  PubMed  Google Scholar 

  29. Wilens TE, Adler LA, Adams J, et al. Misuse and diversión of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21–31.

    Article  PubMed  Google Scholar 

  30. Biederman J, Wilens T, Mick E, Spencer T, Faraone SV. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. 1999;104(2):e20.

    Article  PubMed  CAS  Google Scholar 

  31. Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003;11:179–85.

    Article  Google Scholar 

  32. Miller CJ, Flory JD, Miller SR, Harty SC, Newcorn JH, Halperin JM. Childhood ADHD and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psychiatry. 2008;69(9):1477–84.

    Article  PubMed  Google Scholar 

  33. Phillipsen A, Limberger MF, Lieb K, et al. Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. Br J Psychiatry. 2008;192:118–23.

    Article  Google Scholar 

  34. Fischer M, Barkley RA, Samallish L, Fletcher K. Young adult follow-up of hyperactive children: self-reported psychiatry disorders, comorbidity, and the role of childhood conduct problems and teen CD. J Abnorm Child Psychol. 2002;30:463–75.

    Article  PubMed  Google Scholar 

  35. Dijk FE, Lappenschaar M, Kan CC, Verkes R, Buitelaar JK. Symptomatic overlap between attention-deficit/hyperactivity disorder and borderline personality disorder in women: the role of temperament and character traits. Compr Psychiatry. 2012;53(1):39–47. doi:10.1016/j.comppsych.2011.02.007.

    Article  PubMed  Google Scholar 

  36. Golubchik P, Server J, Zalsman F, Weizman A. Methylphenidate in the treatment of female adolescents with cooccurrence of attention deficit/hyperactivity disorder and borderline personality disorder: a preliminary open-label trial. Int Clin Psychopharmacol. 2008;23(4):228–31.

    Article  PubMed  Google Scholar 

  37. Biederman J, Petty C, Clarke A, Lomedico A, Faraone SV. Predictors of persistent ADHD: an 11-year follow-up study. J Psychiatr Res. 2011;45:150–5.

    Article  PubMed  Google Scholar 

  38. Green RW, Ablon SJ. Treating explosive kids. New York: Guildford; 2006.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Medical Psychology, University of Navarra Clinic (Madrid Campus), Calle General Lopez Pozas, 10, Madrid, 28036, Spain

    Inmaculada Escamilla M.D., Ph.D.

Authors
  1. Inmaculada Escamilla M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Inmaculada Escamilla M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Alewife Brook Parkway, Suite 2000 185, Cambridge, 02138, USA

    Craig B.H. Surman

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Escamilla, I. (2013). Managing ADHD in Adolescence and Young Adulthood: Emerging Comorbidities and Tailored Treatment. In: Surman, C. (eds) ADHD in Adults. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-248-3_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-248-3_9

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-247-6

  • Online ISBN: 978-1-62703-248-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation