Comorbidity prevalence and treatment outcome in children and adolescents with ADHD
Abstract
Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.
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A wide range of comorbid behavioral and psychiatric conditions are associated with ADHD, including learning disabilities, language disorders, mood disorders, anxiety, and conduct/oppositional disorder.
“A wide range of comorbid behavioral and psychiatric conditions are associated with ADHD, including learning disabilities, language disorders, mood disorders, anxiety, and conduct/oppositional disorder (Reale et al., 2017).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Reale et al., 2017
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Executive Functioning and Emotion Regulation in Children with and without ADHD
Groves, N. B., Wells, E. L., Soto, E. F., Marsh, C. L., Jaisle, E. M., Harvey, T. K., & Kofler, M. J. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00883-0 · Cited by 110 · see citing works
Sex Differences in Comorbidity Patterns of Attention-Deficit/Hyperactivity Disorder
Ottosen, C., Larsen, J. T., Faraone, S. V., Chen, Q., Hartman, C., Larsson, H., Petersen, L., & Dalsgaard, S. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.07.910 · Cited by 96 · see citing works
Lee, C. S. C., Ng, K.-H., Chan, P. C. K., & Peng, X. (2022) · Hong Kong Journal of Occupational Therapy · doi:10.1177/15691861211073826 · Cited by 28 · see citing works
Lilja, M. M., Sandblom, E., Lichtenstein, P., Serlachius, E., Hellner, C., Bhagia, J., & Halldner, L. (2022) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-022-09424-2 · Cited by 14 · see citing works
Moldekleiv, C. D., Lundervold, A. J., Solberg, B. S., Engeland, A., Fadnes, L. T., Chalabianloo, F., & Klungsøyr, K. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07305-1 · Cited by 8 · see citing works
- Authors
- on behalf of Lombardy ADHD Group, Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., Termine, C., & Bonati, M.
- Affiliations
- Mario Negri Institute for Pharmacological Research (IT)
- University of Insubria (IT)
- University of Milan (IT)
- Corresponding author
- Reale, Laura
- ORCID
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2017-05-19
- Volume
- 26
- Issue
- 12
- Pages
- 1443-1457
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- OpenAlex
- W2614422271
- Cited by
- 414
- References
- 92
- Citations by year
- 2026: 30 · 2025: 50 · 2024: 53 · 2023: 58 · 2022: 74 · 2021: 61 · 2020: 42 · 2019: 29 · 2018: 11 · 2017: 5
- FWCI
- 19.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, comorbidities, psychiatric comorbidity, children and adolescents, learning disabilities, sleep disorders, oppositional defiant disorder, anxiety disorders, methylphenidate, combination therapy, treatment outcomes, combined type ADHD, ADHD symptom severity
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, Comorbidity, Prevalence, Treatment Outcome
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