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Ask the expert
Concomitant disorders

Why study sleep in relation to ADHD?

Several human functions are strongly affected by insufficient sleep and include executive functions, self regulation and arousal. These are also the key domains of dysfunction in children with ADHD.
Clinicians have reported sleep problems in an estimated 25-50% of children with ADHD, and studies have indicated that sleep disruption is associated with externalization, hyperactivity and inattention. Sleep difficulties in children with ADHD may increase daytime symptoms and present a considerable challenge for clinicians attempting to develop effective ADHD treatment strategies.

A better understanding of this issue is needed in order to develop new sleep-based therapeutic strategies for ADHD.

Is there a link between ADD and panic disorder?

Anxiety disorders are more frequent in individuals with ADHD than in the general population.

Ridha Joober, MD, PhD. and Natalie Grizenko, MD, 2008

Can ADHD symptoms be mistaken for autism or PDD?

Symptoms of ADHD are often observed in children suffering from pervasive developmental disorder (PDD).

Ridha Joober, MD, PhD. and Natalie Grizenko, MD, 2008

Can attention deficit disorder appear with symptoms of confabulation?

Yes, ADD can be concomitant with confabulation.
Ridha Joober, MD, PhD. and Natalie Grizenko, MD, 2008

Should people who are suspected of having ADHD and who are depressed be treated more for ADHD?

That depends. If the depression is major, I would start by treating the depression and see what happens. On the other hand, if the depression is not severe, the signs clearly indicate ADHD, and the depression is a reaction to life's ups and downs, I sometimes start by treating the ADHD. I use my clinical judgement in each case.
-Ridha Joober, MD, PhD, Mini-Psych School 2010

Can an eight-year-old child with unmedicated ADHD have problems with insomnia?

Yes. In fact, difficulties falling asleep are often observed in children with ADHD. I have also seen some cases of advanced sleep phase syndrome or delayed sleep phase syndrome. Advanced sleep phase syndrome is when people tend to go to sleep very early and wake up very early. Although a rare condition, it does impair attention levels, because if children wake up at 5:00 a.m., they will of course be very tired by 10:00 a.m., which can lead people to think that the child has attention deficit disorder. Delayed sleep phase syndrome, which is much more frequent, produces the opposite effect. People tend to go to sleep very late and wake up very late. If children go to bed late, they still have to wake up early for the beginning of classes and will be tired.
-Ridha Joober, MD, PhD, Mini-Psych School 2010

At what age does the relationship between ADHD and borderline personality disorder appear?

Not a lot of attention has been paid to this question, and few studies have been carried out in this area. A number of symptoms of borderline personality disorder and attention deficit disorder are similar, such as impulsiveness and instability. Although I don't have scientific arguments to prove this, I believe that a large number of people with borderline personalities also suffer from attention deficit disorder. Psychosis is also commonly associated with ADHD. For example, among the youth in our clinic who suffer from a psychotic disorder, we determined that up to 25% of them have an attention deficit disorder. I think that this problem is widely underestimated and should be examined more closely.
-Ridha Joober, MD, PhD, Mini-Psych School 2010

Are autism and ADHD related?

They are not related, but a good proportion of people with autism have a clinical profile of ADHD. Autistic children can also have comorbid ADHD, which occurs in probably 30% of cases. Another condition that is also highly comorbid with ADHD is Tourette syndrome (the tic disorder), as 60% of these patients will also have ADHD.
-Ridha Joober, MD, PhD, Mini-Psych School 2010

Is there a link between ADHD in childhood and psychosis later in life?

The epidemiologic link between the two is probably not very obvious. What we know is that the pathways of ADHD can lead to psychotic disorders, which is a subject that requires further research. For example, we know that people with ADHD are at a high risk of using drugs and dropping out of school. People with this condition don’t always have the healthiest lifestyles. There are also pathways that can lead to psychosis. Although this question has not been on the radar of researchers for a long time, we have started looking at it in our own programs, such as the PEPP. We find that about 25% of young people who experience psychotic disorders have either diagnosed ADHD or a large number of similar symptoms even if they are not diagnosed. At least in the first episode, we see quite a bit and probably a higher proportion of ADHD than in the general population. What complicates things is that people with ADHD can forget to take their medication and tend to “rebel” against medication, which can make things worse. I think we have to be very attentive to this potential issue, particularly during the first episode.
- Ridha Joober, MD, PhD, Mini-Psych School 2012

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