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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
Comorbid Condition # 1 - Learning Disabilities
Comorbid Condition # 2 - Substance Abuse
Comorbid Condition # 3 - Antisocial Personality Disorder
Comorbid Condition # 4 - Tourettes Syndrome
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
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
-- 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.
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., 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.
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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