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ADHD in Adults - it often brings a friend and doesn’t always start in childhood

Apr 12, 2024

Exploring the intricate world of ADHD, especially in adults, reveals a landscape filled with complexities like comorbid psychiatric conditions that often accompany it. A study published in January 2024 by Adeel Sarwar throws light on this subject, uncovering how common it is for individuals with ADHD to face additional challenges like anxiety disorders, particularly among non-binary and transgender groups.

What’s intriguing is the conversation around adult-onset ADHD, suggesting that it’s not just a continuation from childhood but can represent a distinct pathway in one’s life. This perspective invites us to rethink how we approach ADHD, especially in adult populations, and the need for healthcare services that cater to the unique experiences across various gender identities.

As we dive deeper, it becomes clear that understanding ADHD in its full complexity, including its comorbidities, is crucial for effective diagnosis and treatment, ensuring that no one is left behind in our quest for better mental health care.

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Table of Contents

About the study

The study, 'Evaluation of the Relationship between ADHD and Comorbid Psychiatric Conditions: A Comprehensive Study on a Large Cohort' by Adeel Sarwar, was published in the Open Access Library Journal in January 2024. It explored the complexities of ADHD and associated psychiatric conditions through an analysis of 1528 individuals, predominantly from the USA, UK, and Canada. These participants, spanning a range of gender identities, were engaged via the online platform, The methodology was structured as follows:

1. Data Collection: The research utilized the website to collect data from people diagnosed with severe ADHD, encompassing a diverse group from various nationalities.

2. Ethical Considerations: Conducted under strict ethical standards, the study ensured the privacy and informed consent of all participants, guaranteeing the confidentiality and integrity of the data collected.

3. Diagnostic Approach: A proprietary algorithm from, consistent with established DSM-5 criteria, was used to diagnose ADHD and assess any coexisting psychiatric conditions.

4. Analytical Focus on Gender Diversity: In analyzing the data, the study paid particular attention to gender diversity, examining the prevalence of comorbid psychiatric conditions among different gender identities.

This methodological approach facilitated a deep dive into the nuanced experiences of ADHD among adults from the USA, UK, and Canada, offering valuable insights into the disorder’s complex nature and its intersection with gender and comorbidity.

Adult onset ADHD

The study sheds light on the concept of adult-onset ADHD, expanding the understanding of how this condition can emerge later in life, beyond the traditional view that it originates only in childhood. Here are the critical insights:

1. Existence and Acknowledgment: Adult-onset ADHD is acknowledged, indicating that individuals may first experience symptoms or receive a diagnosis well into adulthood, which challenges the conventional perspective that ADHD is solely a developmental disorder of childhood.

2. Identification Challenges: The research highlights the difficulties in identifying ADHD in adults, as its symptoms can often be mistaken for or masked by other life stresses or psychiatric conditions. This difficulty emphasizes the need for careful and comprehensive assessment in adults presenting with attentional problems or other related symptoms.

3. Unique Presentation: The study suggests that ADHD in adults can present differently than in children, with varying symptoms and impacts on daily functioning. Adults may experience more subtle symptoms, such as difficulties with time management, organization, and sustaining attention, which can significantly affect their professional and personal lives.

Overall, the study contributes to a growing body of evidence that ADHD is not just a disorder of childhood but can also have a distinct onset in adulthood. Recognizing and understanding adult-onset ADHD is crucial for providing appropriate support and treatment to those affected, ensuring they receive the help they need to manage their symptoms effectively.

Understanding ADHD and Its Common Comorbidities

The study unveils intriguing patterns in the prevalence of comorbid psychiatric conditions among individuals with ADHD, illuminating the intricate interplay between ADHD and other mental health disorders. It reveals that ADHD rarely exists in isolation, often co-occurring with a range of psychiatric conditions that complicate its diagnosis and management. This significant interconnection underscores the need for a holistic approach to understanding and treating ADHD, ensuring that the full spectrum of an individual's mental health is considered. The findings stress the importance of recognizing these comorbidities to tailor more effective and comprehensive treatment plans for those living with ADHD.

Anxiety Disorders Lead Among Comorbidities

Anxiety disorders topped the list, affecting a whopping 40.4% of those with ADHD. This finding lines up with what we know about the strong link between ADHD and anxiety. So if you have ADHD, there's a good chance you might also struggle with anxiety. But you're definitely not alone in this.

The Spectrum of Comorbid Conditions

The study revealed a wide range of other psychiatric conditions that commonly tag along with ADHD. Here's a quick rundown:

  • OCD: 12.5%
  • Insomnia: 11.3%
  • PTSD: 8.6%
  • Autism: 6.2%
  • Dyslexia: 4.1%
  • Substance abuse: 4.1%
  • Bipolar disorder: 4.0%
  • Borderline personality disorder: 3.5%
  • Dysgraphia: 0.6%

As you can see, the possibilities are all over the map. From learning disorders to personality disorders to substance abuse, ADHD seems to increase the risk for a lot of different issues.

Gender Differences in ADHD and Comorbidity Rates

Now let's talk about how gender plays into all of this. The study found some interesting differences in comorbidity rates across gender identities.

For females with ADHD, 44.97% had no pre-existing conditions, highlighting the variability in how ADHD presents across genders. Anxiety emerged as the top comorbidity among non-binary individuals (63.2%) and transgender individuals (37.5%). While the study didn’t specify the prevalence of comorbid conditions for males with ADHD, it’s recognized that males with ADHD also commonly experience comorbid psychiatric conditions, including anxiety, though the exact prevalence rates were not detailed in this study.

Autism rates were also notably high in these groups, with 26.3% of non-binary people and 31.3% of transgender folks reporting both ADHD and autism. Clearly, gender identity is an important factor to consider when it comes to comorbidities.

The Unique Challenges Faced by Females with Severe ADHD

Let's dive a little deeper into the experience of females with severe ADHD. What kind of comorbidities are they dealing with?

Anxiety took the top spot again at 37.3%. After that, rates dropped significantly:

  • OCD: 7.94%
  • Insomnia: 5.82%
  • PTSD: 3.17%
  • Bipolar disorder: 2.65%
  • Autism: 2.12%
  • BPD: 1.59%
  • Substance abuse: 1.59%
  • Dyslexia: 0.53%
  • Dysgraphia: 0.26%
  • Schizophrenia: 0.26%

Imagine trying to manage severe ADHD while also navigating conditions like bipolar disorder or autism. It's a lot for anyone to handle.

The Intersection of ADHD and Autism Spectrum Disorder

One comorbidity that deserves a closer look is autism spectrum disorder (ASD). In the study, ASD was notably prevalent among non-binary individuals with ADHD, affecting 26.3% of them. Similarly, 31.3% of transgender individuals with ADHD also had ASD. These significant percentages highlight the importance of considering ASD in the diagnostic and treatment processes, especially in non-binary and transgender populations with ADHD.

Addressing Insomnia in Individuals with ADHD

Insomnia is another common comorbidity in ADHD, affecting 11.3% of the study participants. Sleep problems and ADHD often go hand-in-hand.

Poor sleep can worsen ADHD symptoms like inattention and hyperactivity. And the racing thoughts and restlessness of ADHD can make it harder to fall asleep. It's a vicious cycle.

If you have ADHD and insomnia, talk to your doctor. There are treatments that can help, like cognitive behavioral therapy and medication. Don't suffer in silence - quality sleep is so important for managing ADHD.

Substance Abuse as a Comorbidity

Substance abuse is another concern for people with ADHD, showing up in 4.1% of the study sample. This link isn't surprising when you consider the impulsivity and risk-taking behavior associated with ADHD.

Some people with ADHD may turn to drugs or alcohol to cope with their symptoms or the stress of living with the disorder. But substance abuse will only make things worse in the long run.

If you're struggling with addiction and ADHD, reach out for help. There are specialized treatment programs that can address both issues together.

Navigating Comorbid OCD and PTSD in the Context of ADHD

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are two more psychiatric conditions that can complicate life with ADHD.

In the study, 12.5% of participants had both ADHD and OCD, while 8.6% had ADHD and PTSD. These disorders can add new layers of anxiety, intrusive thoughts, and avoidance behaviors.

Treating ADHD alongside OCD or PTSD requires a delicate balance. Stimulant medications for ADHD may worsen anxiety symptoms, so careful monitoring is key. Therapy can be a helpful tool for managing all three conditions.

Dyslexia and Dysgraphia - The Overlooked Comorbidities

Dyslexia and dysgraphia are two learning disorders that often fly under the radar in ADHD. But they're more common than you might think, affecting 4.1% and 0.6% of the study participants respectively.

These disorders can make reading, writing, and spelling even more challenging for people with ADHD. But with the right accommodations and interventions, it's possible to thrive.

If you suspect you have dyslexia or dysgraphia in addition to ADHD, don't hesitate to seek an evaluation. The sooner you get support, the better.

Bipolar Disorder and Borderline Personality Disorder alongside ADHD

Bipolar disorder (BD) and borderline personality disorder (BPD) are two serious mood disorders that can coexist with ADHD. In the study, 4.0% of participants had bipolar disorder and 3.5% had BPD.

The impulsivity and emotional dysregulation of ADHD can look a lot like the symptoms of bipolar disorder or BPD. This overlap can make diagnosis tricky, but it's crucial to get it right.

Misdiagnosis is common, so if you have ADHD and suspect a mood disorder, seek out a thorough evaluation from a qualified professional. With an accurate diagnosis, you can get the targeted treatment you need.

Living with ADHD and any of these comorbidities can be challenging, but you don't have to face it alone. With the right support and treatment plan, a fulfilling life is within reach.


For adults with ADHD, the key takeaway from this study should be the recognition of the potential for various comorbid psychiatric conditions, emphasizing the importance of comprehensive care that addresses both ADHD and any additional mental health issues. Understanding that ADHD in adults can manifest with a range of comorbidities, including anxiety, OCD, and mood disorders, highlights the need for a nuanced approach to treatment that considers these overlapping conditions.

However, it’s crucial to note the study's limitations, including its focus on severe ADHD cases and the specific demographics of the participants, which may not represent the entire adult ADHD community. Adults with ADHD should consider these factors and seek personalized assessments and treatments tailored to their unique experiences and backgrounds. This approach ensures that care plans are reflective of the individual’s specific needs and circumstances, facilitating better management of ADHD and its comorbidities.

Apr 12, 2024

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