From Day 1: ADHD and Comorbid Conditions

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CONFERENCE REPORTER

“It’s important that from day 1 we see the patient, we are looking for comorbidities,” said Napoleon B. Higgins, Jr, MD, at the 2021 NEI Congress in his talk “There’s More to It: ADHD and Comorbidities.” Higgins is President and CEO of Bay Pointe Behavioral Health Services and South East Houston Research Group, Medical Director at Hold My Hand Residential Treatment Center, and executive director of Black Psychiatrists of America.

Higgins recommends considering the common comorbidities that often occur in the context of attention-deficit/hyperactivity disorder (ADHD) when planning treatment, and integrating treatment strategies that address both ADHD and comorbid conditions.

More than 50% of individuals with ADHD have comorbid disorders. Comorbid conditions include learning and language disabilities, mood disorders like depression and mania, anxiety, anger and impulse control disorders, and tic disorders.

Child nutrition, Higgins stressed, is key: “When you have a child's brain being developed on poor nutrition, you are going to have poor outcomes. You cannot have a Cheeto-derived brain.”

Nutritional interventions may be necessary when deciding when to treat or not to treat. “Whatever helps the heart, helps the mind,” Higgins said of dietary behavioral interventions, parallel training, and making sure expectations are clear.

Higgins also stated he focuses on “the trump cards,” or things that must be in control before the ADHD can be treated. These include mania, psychosis, depression, or learning disabilities.

Bipolar disorder and ADHD may be difficult to differentiate, Higgins noted. “I will say that the most common diagnosis that an adult with bipolar disorder will have if they were seen as a child is ADHD. Why is that? Mood issues tend to show up in later adolescence.”

When transitioning to adulthood, according to Higgins, children with ADHD must:

1. Take ownership of their treatment and direct the interview

2. Assist in finding a mental health provider

3. Transition from a child to an adult psychiatrist

4. Be screened for substance abuse

5. Schedule follow-ups during breaks in college

6. Focus outside of educational settings

Beyond medications, Higgins offered the following treatment options as part of ADHD coaching: decreased distractions, time management, self-motivation or self-monitoring, setting goals for the day, prioritizing tasks, breaking things down to pieces, setting a place for work, using a planning system, understanding emotions, and prayer and meditation.