S09 – Trajectories and Misunderstood Comorbidities Associated with Attention-Deficit Hyperactivity Disorder

S09 – Trajectories and Misunderstood Comorbidities Associated with Attention-Deficit Hyperactivity Disorder

Saturday, Oct. 29
14:30 – 15:30 (1 hr)
Meeting Room: Cedar (Mezzanine)
Michael Van Ameringen*, MD, FRCPC; Carolina Goldman Bergmann, MD; Lawrence Martin, MD, FRCPC; Fernando Sumiya, MD

CanMEDS Roles:

  1. Communicator
  2. Medical Expert
  3. Scholar

At the end of this session, participants will be able to: 1) Understand the evidence describing multiple trajectories for attention-deficit hyperactivity disorder (ADHD) across the lifespan; 2) Understand the diagnostic challenges associated with comorbid presentations of ADHD; and 3) Understand the treatment implications associated with ADHD and the comorbid conditions of problematic Internet use, somatic conditions, and autism spectrum disorders.

Attention-deficit hyperactivity disorder (ADHD) is a common mental disorder affecting children, adolescents, and adults and is associated with substantial functional impairment. Although traditionally believed to have an onset in childhood, recent evidence has revealed that there are a group of patients with onset in late adolescence and adulthood. There also appear to be multiple trajectories for the course of ADHD across the life cycle. Reports have suggested that between 65% and 89% of ADHD patients have at least one psychiatric comorbidity, and up to 64% have at least two. Common comorbidities include anxiety disorders, depression, and substance use disorders; however, other comorbid conditions have been less recognized and studied. This symposium will discuss the new evidence on ADHD symptom onset and course, as well as associations and treatment implications for ADHD with the less-recognized comorbid conditions, including problematic Internet use, somatic conditions, and autism spectrum disorders.

S09a – The Course of Attention-Deficit Hyperactivity Disorder (ADHD) and Different ADHD Outcome Trajectories
Carolina Goldman Bergmann, MD

At the end of this session, participants will be able to: 1) Understand the course of attention-deficit hyperactivity disorder (ADHD) during different life stages and treatment approaches; 2) Review the different ADHD outcome trajectories and the diagnostic challenges; and 3) Understand the impact of treatment of trajectories.

Attention-deficit hyperactivity disorder (ADHD) is a chronic, and most common, neurodevelopmental childhood disorder. It occurs in 5.9% of children and teenagers and 2.5% of adults. Characteristic changes occur in the symptoms throughout life. Young children are more likely to have hyperactive-impulsive behaviour, while in middle childhood, inattentive symptoms become more apparent. By late adolescence and into adulthood, inattention and emotional lability tend to persist, with a decline in physical hyperactivity. Children with other psychiatric comorbidities and more severe presentation have a greater risk of persisting with the disorder into adulthood. Although ADHD has always been viewed as a childhood-onset disorder, some patients can meet symptom and impairment criteria at later ages. At every age, recommended treatment of ADHD should be multimodal, including pharmacotherapy, psychoeducation, and psychotherapy. This presentation will address the course of ADHD throughout the lifespan and its outcome trajectories.


  1. Franke B, Michelini G, Asherson P, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 2018;28:1059-88.
  2. Young S, Adamo N, Ásgeirsdóttir BB, et al. Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry 2020;20:404.

S09b – Attention-Deficit Hyperactivity Disorder and Somatic Disorders
Lawrence Martin, MD, FRCPC

At the end of this session, participants will be able to: 1) Identify somatic disorders commonly associated with attention-deficit hyperactivity disorder (ADHD); 2) Discuss assessment and treatment strategies in the face of comorbid illness; and 3) Review evidence for the efficacy of ADHD treatment in improving somatic conditions.

Attention-deficit hyperactivity disorder (ADHD) is associated with increased prevalence of several somatic disorders, most notably obesity and sleep disorders. The incidence of comorbid asthma, migraine, and celiac disease will also be reviewed. The basis for this comorbidity will be explored, considering the role of altered dopaminergic reward systems and physiological requirements for sustained attention and concentration. We will also consider whether there is evidence that appropriate treatment of ADHD has any effect on improving comorbid somatic disorders.


  1. Instanes JT, Klungsøyr K, Halmøy A, et al. Adult ADHD and comorbid somatic disease: a systematic literature review. J Atten Disord 2018;22:203-28.
  2. Cortese S. The association between ADHD and obesity: intriguing, progressively more investigated, but still puzzling. Brain Sci 2019;9:256.

S09c – Attention-Deficit Hyperactivity Disorder with Autism Spectrum Disorder Comorbidity
Fernando Sumiya, MD

At the end of this session, participants will be able to: 1) Understand the evidence describing the biological, cognitive, and behavioural symptom overlap between attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); 2) Understand the diagnostic challenges associated with ADHD-ASD comorbidity; and 3) Understand the implications for treating ADHD in the presence of ASD comorbidity.

Children with autism spectrum disorder (ASD) frequently present with attention-deficit hyperactivity disorder (ADHD) comorbidity. Approximately 1 in 8 children currently diagnosed with ADHD were also diagnosed with current ASD (13.0%). Recent research has indicated that there is substantial biological, cognitive, and behavioural overlap between these two neurodevelopmental disorders, including a strong genetic overlap. The bulk of these studies has attempted to characterize ADHD-ASD comorbidity in child and adolescent populations; however, much less is known about this comorbidity in adult populations. The limited treatment literature has indicated that, although standard ADHD pharmacotherapeutic agents are efficacious in the comorbid presentation, effect sizes and the proportion of responders are much lower than those in the non-ASD population. This presentation will review the current evidence describing ADHD-ASD comorbidity, with a focus on the implications for ADHD treatment and clinical management across the lifespan.


  1. Antshel KM, Zhang-James Y, Wagner KE, et al. An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Rev Neurother 2016;16:279-93.
  2. Zablotsky B, Bramlett MD, Blumberg SJ. The co-occurrence of autism spectrum disorder in children with ADHD. J Atten Disord 2020;24(1):94-103.

S09d – Problematic Internet Use and Attention-Deficit Hyperactivity Disorder
Michael Van Ameringen, MD, FRCPC

At the end of this session, participants will be able to: 1) Understand the prevalence, morbidity, and risk factors associated with problematic Internet use; 2) Understand the impact of attention-deficit hyperactivity disorder (ADHD) and problematic Internet use (PIU) comorbidity; and 3) Understand the lasting negative impact of the COVID-19 pandemic on ADHD and PIU.

Problematic Internet use (PIU) is somewhat of an umbrella term describing a wide range of problematic online behaviours. Although the World Health Organization (WHO) International Classification of Diseases (ICD-11) recognizes gaming, gambling, and compulsive sexual behaviour disorders, there is little evidence to guide clinicians on clinical characteristics and treatments. Nevertheless, PIU has been associated with increased risk for suicidality, even after adjusting for confounding variables, including depression, as well as risks to physical health, making PIU a cause for clinical concern. Attention-deficit hyperactivity disorder (ADHD) is thought to affect 5% to 8 % of the child and adolescent population and 3% to 5 % of the adult population and is associated with substantial functional impairment across life domains. The emerging literature has found a similar comorbidity profile for both PIU and ADHD. Both have been found to be associated with comorbid anxiety disorders, substance addictions, depression, and obsessive–compulsive disorder, as well as with each other. In addition, both PIU and ADHD have been associated with symptom exacerbation during lockdown periods of the COVID-19 pandemic. This presentation will review what is currently known about the characteristics, impact, and treatment of PIU and comorbid ADHD.


  1. Werling AM, Walitza S, Drechsler R. Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey. J Neural Transm (Vienna) 2021;128:1033-43.
  2. Lissak G. Adverse physiological and psychological effects of screen time on children and adolescents: literature review and case study. Environ Res 2018;164:149-57.