ADHD and Psychiatric Comorbidity: Functional Outcomes in a School-Based Sample of Children
Open accessAbstract
Objective: Investigate the prevalence and impact of psychiatric comorbidities in community-based samples of schoolchildren with/without ADHD. Method: Teachers and parents screened children in South Carolina (SC; n = 4,604) and Oklahoma (OK; n = 12,626) for ADHD. Parents of high-screen and selected low-screen children received diagnostic interviews (SC: n = 479; OK: n = 577). Results: Psychiatric disorders were increased among children with ADHD and were associated with low academic performance. Conduct disorder/oppositional defiant disorder (CD/ODD) were associated with grade retention (ODD/CD + ADHD: odds ratio [OR] = 3.0; confidence interval [CI] = [1.5, 5.9]; ODD/CD without ADHD: OR = 4.0; CI = [1.7, 9.7]). School discipline/police involvement was associated with ADHD alone (OR = 3.2; CI = [1.5, 6.8]), ADHD + CD/ODD (OR = 14.1, CI = [7.3, 27.1]), ADHD + anxiety/depression (OR = 4.8, CI = [1.6, 14.8]), and CD/ODD alone (OR = 2.8, CI = [1.2, 6.4]). Children with ADHD + anxiety/depression had tenfold risk for poor academic performance (OR = 10.8; CI = [2.4, 49.1]) compared to children with ADHD alone. This should be interpreted with caution due to the wide confidence interval. Conclusion: Most children with ADHD have psychiatric comorbidities, which worsens functional outcomes. The pattern of outcomes varies by type of comorbidity.
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Boys with ADHD are more likely to exhibit externalizing conditions like oppositional defiant disorder or conduct disorder.
“Boys are more likely to exhibit externalizing conditions like oppositional defiant disorder or conduct disorder.17,19,20”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [19]
The Results report that conduct disorder and oppositional defiant disorder were significantly more common among children with ADHD than among children without ADHD at both study sites. They do not report that boys with ADHD were more likely than girls with ADHD to have these conditions; the sex comparison was not supported by the passages found. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPsychiatric comorbidity, a common reason for exclusion from RCTs, predicts worse outcomes in ADHD.
“These findings might be accounted for, at least partly, by the fact that psychiatric comorbidity—a common reason for exclusion from RCTs—predicts worse outcomes in ADHD.17”
From Evaluating ADHD medication trial representativeness: a Swedish population-based study comparing hypothetically trial-eligible and trial-ineligible individuals (2025) · cites this paper as [17]
The Conclusion and Discussion report that psychiatric comorbidity is associated with worse functional outcomes among children with ADHD. The paper does not state that comorbidity is a common reason for exclusion from RCTs; searches for randomized trials and exclusion criteria found no supporting passage. Its findings concern functional outcomes in a school-based sample of children, rather than outcomes in ADHD generally. (LLM, conf=0.87)
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References 32 · Cited by 175
Research works printed but not linked: 18
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- Authors
- Cuffe, S. P., Visser, S. N., Holbrook, J. R., Danielson, M. L., Geryk, L. L., Wolraich, M. L., & McKeown, R. E.
- Affiliations
- University of Florida (US)
- Centers for Disease Control and Prevention (US)
- University of North Carolina at Chapel Hill (US)
- University of Oklahoma Health Sciences Center (US)
- University of South Carolina (US)
- Corresponding author
- Cuffe, Steven P.
- ORCID
- Venue
- Journal of Attention Disorders
- Publisher
- SAGE Publications
- Published
- 2015-11-25
- Volume
- 24
- Issue
- 9
- Pages
- 1345-1354
- ISSN
- 1087-0547 (ISSN-L)
- 1557-1246
- PMC
- PMC4879105
- OpenAlex
- W2340531511
- Cited by
- 175
- References
- 32
- Citations by year
- 2026: 17 · 2025: 32 · 2024: 23 · 2023: 19 · 2022: 17 · 2021: 12 · 2020: 11 · 2019: 11 · 2018: 12 · 2017: 11 · 2016: 8
- FWCI
- 8.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Attention Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- 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 › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- attention deficit hyperactivity disorder, psychiatric comorbidity, conduct disorder, oppositional defiant disorder, anxiety, depression, academic performance, school retention, student discipline, police involvement, functional outcome, elementary school students
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Child, Humans, Oklahoma, Schools, South Carolina, Comorbidity, Conduct Disorder, Attention Deficit and Disruptive Behavior Disorders
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