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Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007
Open accessAbstract
OBJECTIVE: To determine patterns of comorbidity, functioning, and service use for US children with attention-deficit/hyperactivity disorder (ADHD). METHODS: Bivariate and multivariable cross-sectional analyses were conducted on data from the 2007 National Survey of Children's Health on 61 779 children ages 6 to 17 years, including 5028 with ADHD. RESULTS: Parent-reported diagnosed prevalence of ADHD was 8.2%. Children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability versus 5% without ADHD, 27% vs 2% had a conduct disorder, 18% vs 2% anxiety, 14% vs 1% depression, and 12% vs 3% speech problems (all P < .05). Most children with ADHD had at least 1 comorbid disorder: 33% had 1, 16% had 2, and 18% had 3 or more. The risk for having 3 or more comorbidities was 3.8 times higher for poor versus affluent children (30% vs 8%). Children with ADHD had higher odds of activity restriction (odds ratio: 4.14 [95% confidence interval: 3.34–5.15]), school problems (odds ratio: 5.18 [95% confidence interval: 4.47–6.01]), grade repetition, and poor parent-child communication, whereas social competence scores were lower and parent aggravation higher. Functioning declined in a stepwise fashion with increasing numbers of comorbidities, and use of health and educational services and need for care coordination increased. CONCLUSIONS: Clinical management of ADHD must address multiple comorbid conditions and manage a range of adverse functional outcomes. Therapeutic approaches should be responsive to each child's neurodevelopmental profile, tailored to their unique social and family circumstances, and integrated with educational, mental health and social support services.
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“Psychiatric comorbidities are known to be more common in patients with ADHD, particularly depression, anxiety, and bipolar disorder[4-9,24].”
From Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults (2020) · cites this paper as [6]
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“However, ADHD in adults can be associated with different challenges than those in children and adolescents, such as higher prevalence of psychiatric comorbidities2,17 and functional impairment,7,18 potentially because of increasing life responsibilities and stressors.6,19”
From Health care resource utilization and costs associated with psychiatric comorbidities in adult patients with attention-deficit/ hyperactivity disorder (2024) · cites this paper as [17]
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“The association of ADHD to psychiatric comorbidity has been well described[4-9]”
From Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults (2020) · cites this paper as [6]
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Brancati, G. E., Perugi, G., Milone, A., Masi, G., & Sesso, G. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.06.033 · Cited by 61
Trajectories of academic achievement for students with attention‐deficit/hyperactivity disorder
Lawrence, D. M., Houghton, S. J., Dawson, V., SAWYER, M. G., & Carroll, A. (2020) · British Journal of Educational Psychology · doi:10.1111/bjep.12392 · Cited by 53
ADHD and Delinquency – a Developmental Perspective
von Polier, G. G., Vloet, T. D., & Herpertz‐Dahlmann, B. (2012) · Behavioral Sciences & the Law · doi:10.1002/bsl.2005 · Cited by 60
Why Do We Find it so Hard to Calculate the Burden of Neurodevelopmental Disorders
Cleaton, M. A. M., & Kirby, A. (2018) · Journal of Childhood & Developmental Disorders · doi:10.4172/2472-1786.100073 · Cited by 74
The Prevalence and Comorbidity Rates of ADHD Among School-Age Children in Turkey
Zorlu, A., Ünlü, G., Çakaloz, B., Zencir, M., Büber, A., & Işıldar, Y. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715577991 · Cited by 61
Olfson, M., He, J., & Merikangas, K. R. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2012.12.006 · Cited by 51
Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents
Halldorsdottir, T., & Ollendick, T. H. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2013.08.003 · Cited by 57
Attention-Deficit/Hyperactivity Disorder and Outcome After Concussion: A Systematic Review
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Merzon, E., Weiss, M. D., Krone, B., Cohen, S., Ilani, G., Vinker, S., Cohen, A. G., Green, I., Israel, A., Schneider, T., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105993 · Cited by 52
Heller, M. D., Roots, K., Srivastava, S., Schumann, J., Srivastava, J., & Hale, T. S. (2013) · Games for Health Journal · doi:10.1089/g4h.2013.0058 · Cited by 53
Gómez–Restrepo, C., Aulí, J., Martinez, N. T., Gil, F., Garzón, D., & Casas, G. (2016) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2016.06.010 · Cited by 51
Sleep EEG oscillations in neurodevelopmental disorders without intellectual disabilities
Gorgoni, M., Scarpelli, S., Reda, F., & Gennaro, L. D. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101224 · Cited by 48
Behavioral effects of neurofeedback in adolescents with ADHD: a randomized controlled trial
Bink, M., van Nieuwenhuizen, C., Popma, A., Bongers, I. L., & Boxtel, G. J. M. V. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0655-3 · Cited by 53
Maeir, A., Fisher, O., Bar-Ilan, R. T., Boas, N., Berger, I., & Landau, Y. E. (2014) · American Journal of Occupational Therapy · doi:10.5014/ajot.2014.011700 · Cited by 48
“A ttention deficit hyperactivity disorder (ADHD) is a neurobiological disorder that affects 7%–10% of school-age children (Larson, Russ, Kahn, & Halfon, 2011; Spencer, Biederman, & Mick, 2007) and 2%–6% of pre-school children (Greenhill, Posner, Vaughan, & Kratochvil, 2008).”
Late-Onset ADHD: Understanding the Evidence and Building Theoretical Frameworks
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Higher-order dimensions of psychopathology in a neurodevelopmental transdiagnostic sample.
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Delineating early developmental pathways to ADHD: Setting an international research agenda
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National Trends in Psychotropic Medication Use in Young Children: 1994–2009
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Self-citationMokona, H., Belete, H., Worku, A. G., Zerihun, A., Yimer, S., & Leta, K. (2019) · Behavioural Neurology · doi:10.1155/2019/1753580 · Cited by 46
“In other studies, the prevalence rate of ADHD has been reported to be 8.2% among children aged 6 to 17 years in the USA [7], 6.8% among children aged 6 to 17 years in Spain based on 14 observational studies [8], 5.8% among children aged 6 to 17 years in Brazil using the Diagnostic and Statistical Manual of Mental Diso…”
BackgroundInfluentialBrowning, M. H. E. M., & Rigolon, A. (2019) · Environmental Research · doi:10.1016/j.envres.2019.04.016 · Cited by 45
What Makes an Intervention a Life Course Intervention?
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Self-citationSleep Problems and Early Developmental Delay: Implications for Early Intervention Programs
Bonuck, K. A., & Grant, R. (2012) · Intellectual and developmental disabilities · doi:10.1352/1934-9556-50.1.41 · Cited by 44
Yang, K. G., Flores, M. W., Carson, N. J., & Cook, B. L. (2022) · Psychiatric Services · doi:10.1176/appi.ps.202100578 · Cited by 42
Garner, A. A., Mrug, S., Hodgens, B., & Patterson, C. S. (2012) · Journal of Attention Disorders · doi:10.1177/1087054711431456 · Cited by 47
Reduced Cortisol in Boys with Early-Onset Conduct Disorder and Callous-Unemotional Traits
von Polier, G. G., Herpertz‐Dahlmann, B., Konrad, K., Wiesler, K., Rieke, J., Heinzel‐Gutenbrunner, M., Bachmann, C., & Vloet, T. D. (2013) · BioMed Research International · doi:10.1155/2013/349530 · Cited by 43
Breaux, R., Brown, H. R., & Harvey, E. A. (2016) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-016-0213-1 · Cited by 47
Assessment and Treatment of Anxiety Among Children and Adolescents
Freidl, E. K., Stroeh, O. M., Elkins, R. M., Steinberg, E. J., Albano, A. M., & Rynn, M. A. (2017) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20160047 · Cited by 56
Metadata
- Authors
- Larson, K., Russ, S. A., Kahn, R. S., & Halfon, N.
- Affiliations
- University of California, Los Angeles (US)
- Cedars-Sinai Medical Center (US)
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Larson, Kandyce
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2011-03-01
- Volume
- 127
- Issue
- 3
- Pages
- 462-470
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3065146
- OpenAlex
- W2133663175
- Cited by
- 580
- References
- 74
- Citations by year
- 2026: 16 · 2025: 30 · 2024: 27 · 2023: 39 · 2022: 42 · 2021: 43 · 2020: 47 · 2019: 51 · 2018: 46 · 2017: 39 · 2016: 45 · 2015: 48 · 2014: 37 · 2013: 34 · 2012: 23
- FWCI
- 22.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Health Resources and Services Administration
- U.S. Public Health Service (2T76M600014:11)
- Maternal and Child Health Bureau
- 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, comorbidities, children, functioning, service utilization, learning disabilities, conduct disorder, anxiety, depression, speaking difficulties, socioeconomic status, school problems, school retention, parent-child communication, social competence, care coordination, National Survey of Children's Health
- MeSH terms
- Adolescent, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Child, Cross-Sectional Studies, Humans, Learning Disabilities, Mental Health, Retrospective Studies, United States, Comorbidity, Prevalence, Delivery of Health Care, Integrated
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