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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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Polypharmacy with antidepressants in children and adolescents
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“2007), high prevalence and severity of co-morbidity between the two disorders often call for the use of additional strategies (Larson et al. 2011).”
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“…hyperactive/impulsive or combined) (American Psychiatric Association, 2013), and psychiatric comorbidity is present in up to two-thirds of children (Larson, 2011; Spencer, 2006; Yoshimasu et al., 2012) Consequently, ADHD is a heterogeneous disorder, and the presentations and comorbidities are…”
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“Among ADHD cases, comorbid diagnosis of autism spectrum disorders (ASD) are found in 10–33% [4, 5], conduct disorder (CD) in 16–18% [6, 7], learning and coordination disorders in 15–46% [4, 6, 7] and mental retardation in 4–8% [4, 6].”
Attention deficit hyperactivity disorder
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Early Development of Comorbidity Between Symptoms of ADHD and Anxiety
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Anxiety in Young People With ADHD
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“A lower prevalence of comorbid anxiety disorder was found in previous cohorts from Western countries using other diagnostic measures (Bedard & Tannock, 2008; Jensen, 2009; Jensen et al., 2001; Larson et al., 2011), though a higher prevalence was reported from the NIMH Multimodal Treatment Study of Children With Attent…”
BackgroundMethodResultInfluentialAttention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviors in Children
Tong, L., Xiong, X., & Tan, H. (2016) · PLOS ONE · doi:10.1371/journal.pone.0163434 · Cited by 39
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Diagnosis and treatment of ADHD in children vs adults: What nurses should know
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Clinical practice guidelines for attention-deficit/hyperactivity disorder: recent updates
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Asperger's syndrome: What to consider?
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“…with ADHD, the risk of an anxiety disorder is 7.45 times greater than for those without an ADHD diagnosis, the risk of depression is 8.04 times greater, the risk of an autism spectrum disorder is 8.72 times greater, and the risk of Tourette syndrome is 10.70 times greater (Larson et al., 2011).”
BackgroundInfluentialCurrent Australian Pediatric Practice in the Assessment and Treatment of ADHD
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“This is consistent with previous Australian data17 and also with data reported from the 2007 US National Survey of Children’s Health.18 However the rates reported for certain key comorbidities, such as anxiety and disruptive behavior disorders, were substantially lower than expected from previous studies.”
ResultLeaberry, K. D., Rosen, P. J., Fogleman, N. D., Walerius, D. M., & Slaughter, K. E. (2020) · Journal of Attention Disorders · doi:10.1177/1087054717734647 · Cited by 35
“Research has indicated that approximately 30% of children with ADHD have a comorbid internalizing disorder (Larson et al., 2011).”
BackgroundADHD Symptoms and Financial Distress
Liao, C. (2020) · European Finance Review · doi:10.1093/rof/rfaa013 · Cited by 35
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“health problems often emerge in early development, are relatively persistent, and interfere with the child’s and the family’s everyday life (Einfeld et al., 2006; Herring et al., 2006; Larson et al., 2011).”
BackgroundAdolescents With ADHD Do Not Take Longer to Recover From Concussion
Cook, N. E., Iverson, G. L., Maxwell, B., ZAFONTE, R. D., & Berkner, P. D. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2020.606879 · Cited by 35
“We did not attempt to control for this difference because ADHD is commonly comorbid with depression (44); thus, excluding cases with comorbid depression or otherwise controlling for this covariate would have substantially decreased the representativeness of our ADHD sample.”
BackgroundPrenatal Opioid Exposure and ADHD Childhood Symptoms: A Meta-Analysis
Schwartz, A. N., Reyes, L. M., Meschke, L. L., & Kintziger, K. W. (2021) · Children · doi:10.3390/children8020106 · Cited by 36
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Examining the effects of ADHD symptoms and parental involvement on children’s academic achievement
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“These results contrasted with some prior research indicating that co-occurring conditions are associated with worse academic outcomes for children with ADHD (Larson et al., 2011).”
Distracted Driving in Teens With and Without Attention-Deficit/Hyperactivity Disorder
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Background, clinical features and treatment of attention deficit hyperactivity disorder in children
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A Single-Subject Study of a Technology-Based Self-Monitoring Intervention
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“ADHD, one of the most common disorders of school-age children with a parent-reported prevalence rate of about 8 %, is often comorbid with other mental health/ neurodevelopmental disorders [e.g., learning disabilities (LD), conduct disorder, anxiety, depression, speech disorders; Larson et al. 2011].”
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“Further research could include additional information from a professional regarding the ADHD type and comorbidity, such as sensory modulation dysfunction, learning disabilities, and/or DCD, which is common in this population [27,46,48].”
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ADHD and Depression: the Role of Poor Frustration Tolerance
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Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample
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Conflict between Parents and Adolescents with ADHD: Situational Triggers and the Role of Comorbidity
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“However, less attention has focused on the increase prevalence rates of ADHD and co-occurring depression in adolescence (Kessler et al. 2012; Larson et al. 2011).”
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“Attention-deficit and hyperactivity-disorder (ADHD) affects 5–8% of the worldwide childhood population, it has high comorbidity and it shares symptoms with other behavioral and emotional disorders (Boyle et al., 2011; Larson et al., 2011).”
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“Children and adolescents with ADHD commonly exhibit additional psychiatric and neurologic comorbidities (Larson et al., 2011).”
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BackgroundPoverty and Trends in Three Common Chronic Disorders
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RetractedAccuracy of Electronic Health Record–Derived Data for the Identification of Incident ADHD
Daley, M. F., Newton, D. A., DeBar, L., Newcomer, S. R., Pieper, L. E., Boscarino, J. A., Toh, S., Pawloski, P. A., Nordin, J. D., Nakasato, C. C., et al. (2014) · Journal of Attention Disorders · doi:10.1177/1087054713520616 · Cited by 24
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Attentional profile of adolescents with ADHD in virtual-reality dual execution tasks: A pilot study
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“Several studies have found high comorbidity in more than 50% of cases of ADHD in children and young people (Kessler et al., 2006; Larson et al., 2011), increasing with age (Gau et al., 2010; Inci et al., 2019; P. S. Jensen et al., 2001; Y€uce et al., 2013).”
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“Adolescents diagnosed with attention - deficit/hyperactivity disorder (ADHD) and/or autism, are at increased depression risk (Lai et al., 2019; Larson et al., 2011; Leyfer et al., 2006; Reale et al., 2017; Simonoff et al., 2008).”
Ocular findings in children with attention deficit hyperactivity disorder: A Case–Control study
Ababneh, L. T., Bashtawi, M. A., Ababneh, B. F., Mahmoud, I. H., Rashdan, M., & Zahran, M. (2020) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2020.08.005 · Cited by 22
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“Comorbid psychiatric disorders are present in up to 67% of ADHD pediatric-adolescent patients (21) and almost 80% of adults (22).”
BackgroundA Scoping Review of Peer Mentoring Programs for Autistic College Students
Morris, I. F., Matta, C., & Fung, L. K. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00325-7 · Cited by 25
“For example, executive functioning challenges and co-occurring mental health conditions are common in autistic individuals as well as those with ADHD and learning disabilities (Autism Spectrum Australia, 2013; Jackson et al., 2018; Kessler et al., 2006).”
InfluentialBetts, K. A., Sikirica, V., Hodgkins, P., Zhou, Z., Xie, J., DeLeon, A., Erder, M. H., & Wu, E. Q. (2014) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2013.0107 · Cited by 22
“Furthermore, this noncomorbid subpopulation will not be generalizable to the entire ADHD population, many of whom are characterized as having a heavy co-morbidity burden (Larson et al. 2011).”
An Examination of Teacher Trainees’ Knowledge of Attention-Deficit/Hyperactivity Disorder
Canu, W., & Mancil, E. B. (2012) · School Mental Health · doi:10.1007/s12310-012-9071-3
Geltman, P. L., Fried, L. E., Arsenault, L. N., Knowles, A. M., Link, D. A., Goldstein, J. N., Perrin, J. M., & Hacker, K. A. (2015) · Academic Pediatrics · doi:10.1016/j.acap.2014.12.002 · Cited by 22
Gellad, W. F., Stein, B. D., Ruder, T., Henderson, R. R., Frazee, S. G., Mehrotra, A., & Donohue, J. M. (2014) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2014.1647 · Cited by 22
Walter, A. W., Yuan, Y., & Cabral, H. (2017) · PEDIATRICS · doi:10.1542/peds.2016-2786g · Cited by 22
Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder
Bioulac, S., Taillard, J., Philip, P., & Sagaspe, P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00003 · Cited by 23
“Children with ADHD commonly exhibit additional mental health and neurodevelopmental comorbidities (7).”
BackgroundHammer, R., Tennekoon, M., Cooke, G. E., Gayda, J., Stein, M. A., & Booth, J. R. (2015) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2015.06.002 · Cited by 21
“…is a ommon neurodevelopmental disorder that affects 5–8% of the orldwide childhood population, is more prevalent in males, has igh heritability (70–80%), and frequent comorbidity with other sychiatric disorders (Boyle et al., 2011; Larson et al., 2011; Thapar t al., 2013; Willcutt et al., 2010).”
Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder
Ronis, S., Baldwin, C., Blumkin, A. K., Kuhlthau, K., & Szilagyi, P. (2015) · Journal of Developmental and Behavioral Pediatrics · doi:10.1097/dbp.0000000000000161 · Cited by 19
“Patient-centered Medical Home Variables Variables of interest included families’ experience with medical home components that may modify their burden for care of a child with ADHD, including (1) access to usual source of care for ill and well visits (yes/no), (2) identification of a personal doctor or nurse (yes/no),…”
BackgroundJogia, J., Sharif, A. H., Nawaz, F. A., Khan, A. R., Alawami, R. H., Aljanahi, M. A., & Sultan, M. A. (2022) · Global Pediatric Health · doi:10.1177/2333794x221076607 · Cited by 21
Zendarski, N. J., Sciberras, E., Mensah, F. K., & Hiscock, H. (2016) · BMC Pediatrics · doi:10.1186/s12887-016-0555-4 · Cited by 21
Hoagwood, K., Kelleher, K. J., Zima, B. T., Perrin, J. M., Bilder, S. M., & Crystal, S. (2016) · Health Affairs · doi:10.1377/hlthaff.2015.1423 · Cited by 21
Findling, R. L., Robb, A. S., DelBello, M. P., Huß, M., McNamara, N., Sarkis, E. H., Scheffer, R. E., Poulsen, L. H., Chen, G., Lemming, O. M., et al. (2017) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2017.0047 · Cited by 22
“This is important given that pediatric patients with ADHD often have a comorbid depressive or anxiety disorder, and there is a frequent use of stimulants in these patients (Daviss 2008; Merikangas et al. 2010; Larson et al. 2011; Cuffe et al. 2015).”
BackgroundCastagna, P. J., Calamia, M. R., Roye, S., Greening, S. G., & Davis, T. E. (2019) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-019-00306-7 · Cited by 23
“Childhood ADHD and anxiety often co-occur (see Jarrett and Ollendick 2008; Schatz and Rostain 2006 for reviews), with comorbidity rates ranging from 11 to 40% in youth (Larson et al. 2011).”
BackgroundDiaz‐Stransky, A., Rowley, S., Zecher, E., Grodberg, D., & Sukhodolsky, D. G. (2020) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2020.0089 · Cited by 21
Symptom Dimensions of Disruptive Behavior Disorders in Adolescent Drivers
Garner, A. A., Gentry, A., Welburn, S. C., Fine, P. R., Franklin, C. A., & Stavrinos, D. (2012) · Journal of Attention Disorders · doi:10.1177/1087054711431699 · Cited by 22
Flouri, E., Midouhas, E., Ruddy, A., & Moulton, V. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-0940-z · Cited by 21
Velõ, S., Keresztény, Á., Dallos, G., Katzenmajer-Pump, L., Móra, K., & Balázs, J. (2021) · Brain Sciences · doi:10.3390/brainsci11040475 · Cited by 19
Winfield, A., Sugar, C., & Fenesi, B. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283227 · Cited by 24
Eadeh, H., Breaux, R., Langberg, J. M., Nikolas, M. A., & Becker, S. P. (2019) · Psychological Assessment · doi:10.1037/pas0000796 · Cited by 20
Jernbro, C., Bonander, C., & Beckman, L. (2019) · Disability and health journal · doi:10.1016/j.dhjo.2019.100841 · Cited by 21
Ghirardi, L., Chen, Q., Chang, Z., Kuja‐Halkola, R., Skoglund, C., Quinn, P. D., D'Onofrio, B. M., & Larsson, H. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13136 · Cited by 20
“…and public health relevance, considering the strong link between ADHD and other NDs in childhood, with comorbidity rates between 30 and 50% (Larson et al., 2011, Koolwijk et al., 2014, Korrel et al., 2017, Grzadzinski et al., 2016, Faraone et al., 2017, Zablotsky et al., 2017, Ghirardi et…”
BackgroundInfluentialLiu, J., Jiang, Z., Li, F., Zheng, Y., Cui, Y., Xu, H., & Li, Y. (2025) · Annals of General Psychiatry · doi:10.1186/s12991-025-00558-w · Cited by 23
“For instance, national mental disorder surveys conducted in Denmark [46], Italy [15], Iran [10] and the US [47] have documented ADHD co-occurrence rates of 52%, 66%, 61%, and 67% respectively.”
Executive Function Deficits in Adolescents With ADHD: Untangling Possible Sources of Heterogeneity
Molitor, S. J., Oddo, L. E., Eadeh, H., & Langberg, J. M. (2018) · Journal of Emotional and Behavioral Disorders · doi:10.1177/1063426618763125 · Cited by 23
DeRosa, J., Rosch, K. S., Mostofsky, S. H., & Nikolaidis, A. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13870 · Cited by 19
Latent Class Analysis of ADHD Neurodevelopmental and Mental Health Comorbidities
Zablotsky, B., Bramlett, M. D., Visser, S. N., Danielson, M. L., & Blumberg, S. J. (2017) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000508 · Cited by 19
Waxmonsky, J. G., Baweja, R. K., Liu, G., Waschbusch, D. A., Fogel, B. N., LESLIE, D. L., & Pelham, W. E. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800473 · Cited by 19
Rutter, T. M., & Arnett, A. B. (2020) · Journal of Attention Disorders · doi:10.1177/1087054720943282 · Cited by 19
“Coexisting psychiatric conditions are associated with greater socioemotional, educational and occupational impairment, and persistence of ADHD symptoms (Biederman et al., 2011; Larson et al., 2011).”
Background
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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