Clinical Patterns of ADHD Comorbidities Across the Lifespan
Attention-deficit/hyperactivity disorder (ADHD) often presents with psychiatric comorbidities—but how do those conditions differ across the lifespan? In this video, Psych Congress faculty member Timothy Wilens, MD, explores common patterns of ADHD comorbidities throughout different developmental stages. Dr Wilens also highlights how comorbid symptom expression differs by sex, and reviews how these differences may track from early life into adulthood.
Key Takeaways for Clinical Practice:
- ADHD is associated with psychiatric comorbidities across the lifespan, beginning in preschoolers with more oppositional and aggressive behaviors, shifting to anxiety in school-age children and depressive symptoms in adolescents, and persisting into adulthood.
- In ADHD, girls have fewer disruptive behavioral disorders such as oppositional and conduct symptoms and aggressivity than boys but slightly higher rates of anxiety disorders and, later, mood disorders.
- Comorbid symptom expression in ADHD differs by sex, with girls more likely to internalize symptoms (withdrawn, isolative, less manifest irritability) and boys more likely to exhibit externalizing symptoms (irritability, anger, explosive reactions around tasks).
Read the Transcript:
Timothy Wilens, MD: Hi, I'm Dr Timothy Willens and I'm chief of the division of child and adolescent psychiatry and co-director for the Center for Addiction Medicine at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School.
Psych Congress Network: Are there gender/sex/age differences in the risk of psychiatric comorbidities that present alongside ADHD?
Wilens: It's interesting when you think about psychiatric co-occurring disorders with ADHD that they're pretty much across the lifespan. We've done studies of preschoolers with ADHD and what was remarkable is that you already start to see comorbidity in that age group.
Now, the type of co-occurring problems you see are different. You may see more oppositional conduct, more aggressivity [in younger children], and as people get older you start to see more anxiety in school-age kids, then maybe more depressive symptoms as you see adolescents with ADHD. Then that all sort of carries through into adulthood.
But what about sex differences or gender differences? What we seem to find is that you see fewer disruptive behavioral disorders in girls. You're going to see less oppositional conduct-type symptoms, aggressivity, etc. Now remember, you can still see them, but it's going to be less so than you see with boys.
Often what we see with girls are slightly higher rates of other co-occurring problems—like anxiety disorders, and as they get a little bit older, mood disorders—than the boys have.
The manifestations of the co-occurring disorders also may be different. Whereas girls may internalize more of these, where you'll see them become isolative, withdrawn, shut down, still with some anger and irritability, but not as manifest, boys may have many more symptoms of externalizing. They're more irritable, angry—I always say seething anger, think mood, they kind of get explosive around tasks, that could be anxiety. You may see those kinds of sex differences, and that tracks into adulthood. So, there are some developmental differences and some sex differences in terms of how comorbidity presents.
Timothy Wilens, MD, is the Chief of Child and Adolescent Psychiatry, and (Co) Director of the Center for Addiction Medicine at the Massachusetts General Hospital. He is a Professor of Psychiatry at Harvard Medical School. Dr. Wilens specializes in the diagnosis and treatment of ADHD, substance use disorders, and bipolar disorder. Widely published, Dr. Wilens has more than 350 original articles, reviews, chapters, books and editorials to his credit. Dr. Wilens is a consultant to the National Football League, Major/Minor League Baseball, Bay Cove Human Services and Gavin House and is consistently named one of the Best Doctors in Boston and in America for psychiatry.
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