Cited by 580Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentDevelopmental and Educational Neuropsychology

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Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007

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Larson, Kandyce, Russ, Shirley A., Kahn, Robert S., Halfon, Neal·2011·Pediatrics

DOI 10.1542/peds.2010-0165PMC PMC3065146

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Abstract

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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Effect of Methylphenidate on State Anxiety in Children With ADHD-A Single Dose, Placebo Controlled, Crossover Study
Kritchmann-Lupo, M., Koubi, M., Mimouni-Bloch, A., & Bloch, Y. (2019) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2019.00106 · Cited by 11
“(Larson et al., 2011; Sciberras et al., 2014).”
Background
Developmental stages and estimated prevalence of coexisting mental health and neurodevelopmental conditions and service use in youth with intellectual disabilities, 2011–2012
Comer-HaGans, D., Weller, B. E., Story, C. R., & Holton, J. E. (2020) · Journal of Intellectual Disability Research · doi:10.1111/jir.12708 · Cited by 11
Clinical Presentation and Treatment of Early-Onset Behavior Disorders: The Role of Parent Emotion Regulation, Emotion Socialization, and Family Income
Highlander, A., Zachary, C., Jenkins, K., Loiselle, R., McCall, M. P., Youngstrom, J., McKee, L. G., Forehand, R., & Jones, D. J. (2021) · Behavior Modification · doi:10.1177/01454455211036001 · Cited by 10
“youth have a behavior disorder (BD), including Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) (e.g., August et al., 1996; Ghandour et al., 2019; Larson et al., 2011; Merikangas et al., 2009).”
Background
Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents
Becker, S. P., Fite, P. J., Vitulano, M. L., Rubens, S. L., Evans, S. C., & Cooley, J. L. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9394-x · Cited by 11
“No known studies have examined this issue in Hispanic youth specifically, even though as noted above Hispanic youth diagnosed with ADHD are more likely than other youth with ADHD to have comorbid mental health disorders (Larson et al. 2011).”
Background
Language Delay in 3-Year-Old Children With ADHD Symptoms
Rohrer-Baumgartner, N., Zeiner, P., Eadie, P. A., Egeland, J., Gustavson, K., Reichborn‐Kjennerud, T., & Aase, H. (2013) · Journal of Attention Disorders · doi:10.1177/1087054713497253 · Cited by 10
“…consequences for cognition, education, and social functioning (Cohen, 2001; Larson, Russ, Kahn, & Halfon, 2011), and children with ADHD and cooccurring LD have been shown to experience worse functioning across domains compared with children with ADHD only (Cohen et al., 2000; Larson et al., 2011).”
Background
The Effects of Instructions on Mothers’ Ratings of Attention-Deficit/Hyperactivity Disorder Symptoms in Referred Children
Johnston, C., Weiss, M. D., Murray, C., & Miller, N. V. (2013) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-013-9789-x · Cited by 12
Health Behaviors, Physical Health, and Health Care Utilization in Children With ADHD
Park, S. J., Jang, H., Lee, Y. A., Kim, C. E., & Park, S. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718775834 · Cited by 11
“In particular, parents of ADHD children with a greater number of physical comorbid disorders often report experiencing greater difficulties in caring for their children and feel more bothered and upset by them (Larson et al., 2011).”
Background
A Network Analysis of Executive Functions in Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder
Karr, J. E., Rodriguez, J. E., Rast, P., Goh, P. K., & Martel, M. M. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01518-9 · Cited by 13
“…which was done to gauge the specific effects that ADHD may have on network parameters; however, the exclusion of participants with comorbid conditions makes the findings less generalizable to the full population of children and adolescents with ADHD, among whom comorbidities are common [62].”
Relationship Between ADHD-Like Traits and Emotion Dysregulation in the Adult General Population
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“ADHD is associated with poorer academic achievement (Arnold et al., 2020; Baweja et al., 2015), difficulties with social functioning (Green & Rabiner, 2012), lower occupational status (Klein et al., 2012), as well as psychological and physical difficulties (Lange et al., 2016; Larson et al., 2011).”
The Temporal Hyper-Morbidity of Asthma and Attention Deficit Disorder: Implications for Interpretation Based on Comparison of Prospective and Cross-Sectional Population Samples
Chai, P. H., Chang, S. Y., & Cawthorpe, D. (2021) · Psychiatry Investigation · doi:10.30773/pi.2020.0349 · Cited by 11
Prevalence of motor problems in children with attention deficit hyperactivity disorder in Hong Kong
Tsui, K. W., Lai, K. Y. C., Lee, M. M. C., Shea, C. K., & Tong, L. C.-T. (2016) · Hong Kong Medical Journal · doi:10.12809/hkmj154591 · Cited by 10
Factors Associated With Educational Support in Young Adolescents With ADHD
Zendarski, N. J., Sciberras, E., Mensah, F. K., & Hiscock, H. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718804351 · Cited by 10
Child with multiple problems: Clinical complexity and uncertainty
McDowell, M. (2018) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.14151 · Cited by 10
ADHD and depressive symptoms in adolescents: the role of community violence exposure
Stickley, A., Koposov, R. A., Koyanagi, A., Inoue, Y., & Ruchkin, V. V. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01662-5 · Cited by 10
Is the Cogmed program effective for youths with attention deficit/hyperactivity disorder under pharmacological treatment?
Dentz, A., Guay, M., Gauthier, B., Romo, L., & Parent, V. (2020) · Applied Cognitive Psychology · doi:10.1002/acp.3631 · Cited by 14
Attention Deficit/Hyperactivity Disorder (ADHD)
Matuszak, J. M. (2020) · Mental Health in the Athlete · doi:10.1007/978-3-030-44754-0_6
Evidence of motor-control difficulties in children with attention deficit hyperactivity disorder, explored through a hierarchical motor-systems perspective
Macoun, S. J., & Kerns, K. A. (2015) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2015.1094028 · Cited by 10
“That being said, a high percentage of children with ADHD present with learning disabilities (Larson et al., 2011), and conducting studies of children with ADHD where learning disabilities have been ruled out could limit the generalizability of the findings to the general population of children with…”
Background
Management of ADHD in children and adolescents: clinical audit in a South African setting
Vrba, K., Vogel, W., & de Vries, P. J. (2016) · Journal of Child and Adolescent Mental Health · doi:10.2989/17280583.2015.1128437 · Cited by 12
Management of Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study
Harstad, E. B., Blum, N. J., Gahman, A. E., Justine Shults, A., Chan, E., & Barbaresi, W. J. (2016) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000329 · Cited by 10
“23 REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data…”
BackgroundMethod
The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center
Lee, S., Choi, J.-W., Kim, K.-M., Kim, J. W., Kim, S.-Y., Kang, T.-W., Kim, J. I., Lee, Y. S., Kim, B., Han, D. H., et al. (2016) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.2016.27.4.236 · Cited by 10
Childhood ADHD With and Without Co-occurring Internalizing/Externalizing Problems: Prospective Predictions of Change in Adolescent Academic and Social Functioning
Reinke, A., Stiles, K., & Lee, S. S. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231187146 · Cited by 9
“However, when defined more particularly in ways that increase the severity of clinical presentation for ADHD (i.e., accompanied by three or more comorbid conditions), co-occurring problems may increment predictions (beyond ADHD) of academic functioning (Larson et al., 2011).”
Background
Helping Clinicians to Detect ODD in Children with ADHD in Clinical Settings
Tahıllıoğlu, A., Doğan, N., Ercan, E. S., & Rohde, L. A. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09855-x · Cited by 9
“The overall prevalence of psychiatric disorders accompanying ADHD in children and adolescents ranges from about 40 to 80% depending on the sample [5, 6].”
Background
Cost Effectiveness of Strategies for Recruiting Low-Income Families for Behavioral Parent Training
Khavjou, O., Turner, P., & Jones, D. J. (2018) · Journal of Child and Family Studies · doi:10.1007/s10826-017-0997-9 · Cited by 9
Are U.S. Schools Discriminating When Suspending Students With Disabilities? A Best-Evidence Synthesis
Morgan, P. L., Wang, Y., Woods, A. D., Mandel, Z., Farkas, G., & Hillemeier, M. M. (2019) · Exceptional Children · doi:10.1177/0014402919868528 · Cited by 10
Forensic psychiatric evaluation and reports of juvenile pushed to crime: A two-year retrospective chart review (tur)
Bilginer, Ç., Karadeniz, S., Bulut, S. H., Yilmaz, B. C., & Kandil, S. T. (2021) · Journal of Clinical Psychiatry · doi:10.5505/kpd.2020.02360 · Cited by 9
Caregiver Preferences Regarding Personal Health Records in the Management of ADHD
Ronis, S. D., Baldwin, C. D., McIntosh, S. E., McConnochie, K. M., Szilagyi, P. G., & Dolan, J. G. (2015) · Clinical Pediatrics · doi:10.1177/0009922814565883 · Cited by 9
“In this structure, ADHD management can be tailored to the needs of children and their families and integrated with efforts of mental health providers, social support services, and other needed specialists.(2) Clinical decision tools integrated with electronic health records (EHR) and electronic personal health records…”
Background
Links Among Attention-Deficit/Hyperactivity Disorder Symptoms and Psycholinguistic Abilities Are Different for Children With and Without Developmental Language Disorder
Redmond, S. M., Ash, A. C., Li, H., & Zhang, Y. (2024) · American Journal of Speech-Language Pathology · doi:10.1044/2024_ajslp-23-00388 · Cited by 11
Reconsidering “Inattention” in Attention-Deficit Hyperactivity Disorder: Implications for Neuropsychological Assessment and Intervention
Carmichael, J. A., Kubas, H. A., Carlson, H. L., Fitzer, K. R., Wilcox, G., Lemay, J.-F., Bray, S., MacMaster, F. P., & Hale, J. B. (2015) · Applied Neuropsychology Child · doi:10.1080/21622965.2015.1005481 · Cited by 10
Temperament Profiles Associated with Internalizing Symptoms and Externalizing Behavior in Adolescents with ADHD
Deotto, A., Eastwood, J. D., & Toplak, M. E. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-01116-z · Cited by 9
Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey
Perry, R. C., Ford, T. J., O’Mahen, H., & Russell, A. E. (2021) · School Mental Health · doi:10.1007/s12310-020-09408-4 · Cited by 10
Psychotropic drug utilization in children with concurrent attention-deficit/hyperactivity disorder and anxiety
Liu, X., Kubilis, P. S., Xu, D., Bussing, R., & Winterstein, A. G. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.06.005 · Cited by 10
The management of attention-deficit hyperactivity disorder in children: updated 2022
Chigome, A., Meyer, J. C., & Schellack, N. (2022) · South African General Practitioner · doi:10.36303/sagp.2022.3.4.0140 · Cited by 8
The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (I) - Clinical Presentation and Comorbidity -
Kim, E. J., Kim, Y., Seo, W. S., Lee, S. H., Park, E. J., Bae, S., & Shin, D. (2017) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.2017.28.2.46 · Cited by 8
Attention-Deficit/Hyperactivity Disorder Symptoms, Depression Risk, and Quality of Life in Black Pregnant Women
Jones, H. A., Eddy, L. D., Bourchtein, E., Parks, A. M., Green, T., Karjane, N. W., & Svikis, D. S. (2018) · Journal of Women s Health · doi:10.1089/jwh.2017.6547 · Cited by 8
“22,41 Furthermore, poorer QoL has been found to be predictive of signiﬁcant symptoms of ADHD 15 or depression, 42 given that both disorders are associated with functional impairment in different domains, such as social relationships.”
Pharmacological treatment of attention-deficit hyperactivity disorder comorbid with an anxiety disorder
Villas-Boas, C. B., Chierrito, D., Fernández-Llimós, F., Tonin, F. S., & Sanches, A. C. C. (2018) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000243 · Cited by 8
“Additionally, many studies involving ADHD exclude patients with AD, although the cooccurrence of both disorders is relatively common, with rates varying from 18 to 47.1% (Kessler et al., 2006; Schatz; Rostain, 2006; Larson et al., 2011; Halldorsdottir et al., 2015; Clemow et al., 2017).”
BackgroundInfluential

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
ORCID: Larson, Kandyce
Russ, Shirley A.
Kahn, Robert S.
Halfon, Neal
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
DOI: 10.1542/peds.2010-0165
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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Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007

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