 "Unravelling the complexity of ADHD")
Public perception of mental health has experienced a shift in recent years, thanks in part to public figures, like Olympian gymnast Simone Biles, who stepped away from the 2021 Tokyo Olympics for her mental health. Biles’ public display of self-care certainly prompted acknowledgment and conversations of the importance of mental health.
Mental health conditions are complex, and rarely travel alone. Among the diversity of mental health conditions, one of the most diagnosed across age and gender is Attention-Deficit/Hyperactivity Disorder (ADHD). About half to a staggering 90 per cent of all children diagnosed with ADHD have a secondary condition, and 85 per cent of adults, have a pre-existing mental health condition at diagnosis. Sometimes, ADHD can present alongside more serious issues that can disrupt daily life and affect long-term wellbeing.
The list of mental health conditions and disorders that co-exist with ADHD is very long, and includes anxiety, depressive and oppositional defiance, eating and bipolar disorders, the autism spectrum, obsessive-compulsiveness, and conduct disorders, borderline personality disorders, and a variety of nervous system conditions. Having combined mental health conditions might lead to substance abuse and/or self-neglect, leading to underemployment and poor lifestyle choices.
Co-existing conditions are common with ADHD, and research is ongoing to learn why such a strong link between comorbid conditions exist. Researchers believe conditions might exacerbate each other, or, that a co-existing condition may overshadow an underlying issue. For example, the challenges of living with ADHD might lead to a depressive state if there is difficulty in maintaining relationships or employment. Feeling demoralised, someone may seek treatment for depression, but fail to get treatment for ADHD. Research shows that 23 per cent of individuals with persistent depressive disorder (a low-grade depression that can’t be adequately treated) have undiagnosed ADHD. The symptoms for anxiety and ADHD are also similar, relating to concentration, restlessness, and time management. Anxiety usually receives treatment, although it may be a side effect of undiagnosed ADHD.
Our genes impact how mental health difficulties play out in someone’s life, and this is especially significant for individuals with ADHD and Autism Spectrum Disorders (ASD). Large-scale research studies have shown evidence for a genetic overlap between ADHD and ASD, with prominent similarities relating to socialisation issues. Both ASD and ADHD are expressed as deficits in social-emotional reciprocity, with problems initiating an appropriate response to social interactions. With both, there may be inadequate eye contact and body language, and deficits in developing and maintaining relationships. What separates ASD from ADHD is the expression of behavior and interest in activities. Individuals with ADHD often lose focus and shift away from eye contact, but those with ASD tend to avoid eye contact completely. Additionally, individuals with ADHD prefer action over discussion (such as playing video games), while those with ASD often prefer to talk about things. Because of these subtle differences, comorbid ADHD is often untreated in people with ASD.
Impact Shorts
More ShortsAn individual, parent, or caretaker needs to ask for careful consideration from their physician to avoid diagnostic overshadowing. A person can have multiple diagnosable conditions, and receive a diverse set of treatment options, from medication, cognitive behavioural therapy, and even physical activity. Further, mental, and physical health changes over time, and re-evaluation might be periodically required. There is no shame in requiring help for multiple conditions. Having a clearer idea of the internal makeup of yourself, your child, a friend, or a family member, can help life become more fulfilling and less stressful. This is particularly important not only when the diagnosis is for multiple mental health conditions, but for mental and physical conditions that can have an immediate impact on day-to-day wellbeing.
The physical conditions that pair alongside ADHD vary in severity, but they can include epilepsy, thyroid disorders, and sensory sensitivities. Sleep disorders are also common and consist of multifaceted conditions that approximately 78 per cent of people ADHD experience.
Sleep is essential for human health, but ADHD-related sleep conditions can exacerbate symptoms. Some of these sleep disorders include insomnia, delayed circadian rhythm, daytime exhaustion and sleepiness, irregular sleep patterns, restless leg syndrome, narcolepsy, and sleep-related breathing disorders. ADHD medications sometimes induce insomnia, posing additional challenges to individuals. Not getting enough sleep can pose serious disruptions in daily life that can impact work and relationships, further impacting mental health.
Having an adjoining diagnosis alongside ADHD is the reality for many individuals. Acknowledging and embracing the complexity of ADHD can be empowering and can lead to a whole-person treatment plan that can lead to better sleep, managed anxiety, treated depression, depression that isn’t unchecked, and ADHD that is understood rather than making each day a hurdle that can’t be tackled.
Living with and understanding the complexities of ADHD might feel exactly like living through a daily Olympic gymnast routine. If we pause to consider how ADHD doesn’t travel alone, just as Simone Biles took a hiatus to prioritise her mental health during the Tokyo Olympics, we might consider how championing our wellbeing is the ultimate prize.
The authors thank Dr Doron Almagor for providing comments about this article Dr. Doron Almagor is Founder and Director of Possibilities Clinic, Toronto, Canada. Mel Lefebvre is Communications Director and Sarojini Sengupta, PhD, is CEO of AIMH. The views expressed in the above piece are personal and solely those of the author. They do not necessarily reflect Firstpost’s views.
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