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10 CEUs Treating Locking In & Blocking Out: ADHD Adults

Section 14
Comorbid Conditions

Question 14 | Test | Table of Contents | ADHD CEU Courses
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed the challenges the ADHD family faces regarding boundaries and communication. We also discussed the "Message Center" tool.

4 Comorbid Conditions
On this track, we will discuss comorbidity in adults with ADHD

Comorbid Condition # 1 - Learning Disabilities
According to Dr. Genel, approximately 65 percent of the ADHD population, both children and adults, will experience comorbidity, or the condition of having two or more diagnosable conditions simultaneously. As you know, the most common comorbid condition for ADHD adults is Learning Disabilities.

Comorbid Condition # 2 - Substance Abuse
The second common comorbid condition for the ADHD adult is Substance Abuse. According to a study by Biederman, 52 percent of ADHD adults meet criteria for substance abuse, compared to only 27 percent of the non-ADHD adult population.

Comorbid Condition # 3 - Antisocial Personality Disorder
Regarding Antisocial Personality Disorder, another common comorbid condition, according to Glenn Brynes, Ph.D., M.D., and Carol Watkins, M.D., between 18 and 25 percent of the ADHD population may also have Antisocial Personality Disorder, compared with two percent of the non-ADHD population.

Comorbid Condition # 4 - Tourettes Syndrome
Regarding Tourettes Syndrome, also a common comorbid condition among ADHD individuals, there has traditionally been controversy regarding the use of stimulant medications to treat ADHD in an adult with the comorbid condition of Tourettes Syndrome. It was once thought that the use of stimulant medications to treat the ADHD would exacerbate, or even cause, tics.

However, recent studies have shown that for some ADHD adults with the comorbid condition of Tourettes Syndrome, stimulant medication for their ADHD has little effect on the presence of tics. I have found that in treating ADHD adults who are comorbid with Tourettes Syndrome, it is important to determine which symptoms are more troublesome to the client: the tics, the inattention, or another behavioral problem. Other comorbid conditions, as you know, include Conduct Disorder, Mood Disorders, and Anxiety.

Treatment of ADHD vs. Effect on Comorbid Condition
Obviously, for ADHD adults with a comorbid condition, one concern regarding treatment of the ADHD is what effect the treatment for the ADHD will have on the comorbid condition. As you know, in ADHD adults with Mood Disorders or Anxiety, for example, the use of a stimulant medication for the ADHD could aggravate the client’s comorbid conditions. So how do you treat an ADHD adult client dealing with a comorbid condition that could be exacerbated by treatment of his or her ADHD? Let’s look at how Laura coped with her comorbid condition.

For Laura, age 29, the recent ADHD diagnosis caused her to develop the comorbid condition of Anxiety. Laura began worrying about nearly everything, especially anything related to her ADHD. Laura worried about how people would react if they found out she had ADHD, as well as what treatment she would need. Laura stated, "The thought of having to take medication for the rest of my life because of my ADHD worries me so much it actually makes me sick."

Laura explained that her anxiety kept her more distracted than she had been before the diagnosis. Laura had also recently upped her smoking habit to two packs a day from one to help her concentrate. Laura stated, "My need to smoke to maintain my concentration has never stopped. If anything, it’s gotten worse because now there are so many more distractions. There are just so many things I have to worry about because of my ADHD! Like, what if my co-workers find out? I don’t know what I’d do!" Sound like one of your recently diagnosed ADHD adult clients?

As you know, some ADHD adults develop smoking habits if they don’t have a prescribed medication for their ADHD. I find this unsurprising, as nicotine is a stimulant that may temporarily relieve some of the symptoms of ADHD. With Laura, I believed that the cigarette addiction had originally started as a method of controlling her undiagnosed ADHD and its symptoms. Now that Laura was diagnosed and had developed the comorbid condition Anxiety, though, the worry about the diagnosis caused her to start smoking more to stay focused. As you may have guessed, the nicotine stimulant was then, in turn, aggravating the anxiety that was distracting her.

"Written Worries" Exercise - 3 Steps
Because I could see Laura was beginning a downward spiral with her smoking behavior for coping with her ADHD diagnosis, I suggested to her a simple activity to help her worry less and decrease her comorbid condition of anxiety. I suggested an exercise called "Written Worries." There are three steps to the "Written Worries" exercise.

-- Step # 1 - First, I gave Laura a notebook and asked her to write down a single worry. Laura wrote, "I’m worried that my co-workers will find out I have ADHD because of my behavior."

-- Step # 2 - Second, I asked her to evaluate her worry, in writing. I stated, "You could consider a few questions in this step, like what can I do to keep my co-workers from finding out about my ADHD? What might happen if they do find out? What is the worst that will happen if they do find out?" Laura wrote, "I can try to control myself and my ADHD tendencies, like disorganization and fidgeting. If they find out, I’m afraid they might think less of me. The worst that could happen is that they could tell my boss."

-- Step # 3 - For the third step, I asked Laura to visualize success. I stated, "Put your writing aside, close your eyes, and visualize managing your ADHD in your workplace." As you know, this visualization would help Laura because it works on the simple principle that people don’t do what they can’t see themselves doing. By having Laura visualize herself controlling her disorganization and fidgeting tendencies, she would be more likely to actually control them. Thus, she would also decrease the amount of time she spent worrying about her ADHD being discovered, and decrease her anxiety.
(Excess Baggage, Judith Sills, p. 147)

Do you have an ADHD adult client with one of the common comorbid conditions, like Antisocial Personality Disorder or Substance Abuse? Or is you ADHD adult client more like Laura, whose comorbid condition is Anxiety? Would your Laura benefit from the "Written Worries" exercise?

On this track, we have discussed the common comorbid conditions of ADHD adults. These common comorbid conditions were Learning Disabilities, Substance Abuse, Antisocial Personality Disorder, Tourettes Syndrome, Conduct Disorder, Mood Disorders, and Anxiety. We also discussed two activities for clients dealing with the comorbid condition of Anxiety, the "Written Worries" exercise.

Peer-Reviewed Journal Article Reference:
Harvey, E. A., Breaux, R. P., & Lugo-Candelas, C. I. (2016). Early development of comorbidity between symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Journal of Abnormal Psychology, 125(2), 154–167.

Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological Assessment, 31(2), 236–247.

Kofler, M. J., Harmon, S. L., Aduen, P. A., Day, T. N., Austin, K. E., Spiegel, J. A., Irwin, L., & Sarver, D. E. (2018). Neurocognitive and behavioral predictors of social problems in ADHD: A Bayesian framework. Neuropsychology, 32(3), 344–355.

Kofler, M. J., Sarver, D. E., Austin, K. E., Schaefer, H. S., Holland, E., Aduen, P. A., Wells, E. L., Soto, E. F., Irwin, L. N., Schatschneider, C., & Lonigan, C. J. (2018). Can working memory training work for ADHD? Development of central executive training and comparison with behavioral parent training. Journal of Consulting and Clinical Psychology, 86(12), 964–979.

Lawson, R. A., Papadakis, A. A., Higginson, C. I., Barnett, J. E., Wills, M. C., Strang, J. F., Wallace, G. L., & Kenworthy, L. (2015). Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders. Neuropsychology, 29(3), 445–453.

Prevatt, F. & Levrini, A. (2015). Case study: ADHD coaching with a young adult with comorbid mood disorders. ADHD coaching: A guide for mental health professionals. Washington, DC, US: American Psychological Association, vi, 189-205.

What percent of the ADHD population will experience a comorbid condition? To select and enter your answer go to Test.

This CD set has covered such topics as: Adult ADHD Challenges, Intense Feelings and Distorted Senses, the Five Steps of Memory, Controlling Methods of Coping, Passive and Aggressive Methods of Coping, the Five ADHD Stages of Grief, Balancing Issues, the Moral Inventory, Slippery Social Situations, Group Interfacing, One-on-One Interactions, Interfacing on the Job, Communication in the ADHD Family, and Comorbid Conditions.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship. 

I wish you the best of luck in your practice. Thank you. 


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