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What Is Complex ADHD?

Medically Reviewed by Dan Brennan, MD on June 01, 2022

ADHD (attention deficit hyperactivity disorder) affects a child's ability to focus, sit still, and practice self-control. About 1 in 20 children have ADHD, but this condition rarely flies solo.

Two out of three kids with ADHD have one or more other problems with learning, behavior, or mood. Doctors call this cluster of conditions complex ADHD.

The most common issues that go along with ADHD are:

  • Defiant or hostile behavior, called oppositional defiant disorder (ODD)
  • Anxiety disorder
  • Depression
  • Autism spectrum disorders
  • Problems with thinking, self-care, and social skills, called intellectual disability
  • Tics, or Tourette syndrome
  • Substance use disorder

Because complex ADHD comes with a range of symptoms that sometimes overlap, it can be hard to diagnose and treat. The stimulant medicines that manage ADHD symptoms may not help with other conditions. Any problems that aren't treated in childhood could stay with kids as they grow up.

Children with complex ADHD do better when they see a team of doctors and mental health providers who have experience managing this disorder, and they get on the right combination of treatments. You can help by looking for symptoms and talking to your child's doctor about them.

What Are the Symptoms?

Many kids have trouble focusing or sitting still sometimes. The difference between typical childhood behaviors and ADHD is that ADHD symptoms are severe enough to affect your child's daily life.

Children with ADHD often:

  • Talk too much
  • Have trouble sitting still and paying attention
  • Have problems getting along with other children and adults
  • Forget or lose things
  • Take risks or act on their urges
  • Make careless mistakes

Each condition that goes along with ADHD has its own set of symptoms. Kids with autism spectrum disorders repeat the same behaviors and have different ways of communicating and interacting with people. Children with ODD argue, refuse to follow rules, and have temper tantrums. And those with tics make repeated movements or sounds they can't control.

Many of these symptoms overlap with ADHD, making it hard to tell them apart. For example, making mistakes at school could be a sign of ADHD or a learning disorder. Temper tantrums are a symptom of ADD and ODD.

How Is It Diagnosed?

Doctors don't have one single test to diagnose complex ADHD. If your child has symptoms, see a child psychologist, child psychiatrist, or developmental pediatrician who has training and experience in diagnosing and treating complex ADHD.

The specialist will ask about your child's symptoms and health history. They can screen for the symptoms of ADHD and conditions that go along with it, such as behavior and learning disorders.

Psychologists use a few different tests and mental health assessments to diagnose complex ADHD. They may ask for input from you, your child's other caregivers, and teachers. The people who know your child best will have the most insight on how ADHD affects their day-to-day life.

What Are the Treatment Options?

Your child's pediatrician or psychologist can often manage ADHD symptoms. But caring for the diverse needs of kids with complex ADHD requires a team of specialists. Each expert will help with a different part of your child's care. 

Your team of specialists might include a:

  • Developmental specialist
  • Child psychologist
  • Nurse practitioner
  • Neurologist

Treatment usually starts by focusing on the condition that causes the most problems, whether that's ADHD or something else. Depending on the conditions involved, your child's treatment plan might include some combination of medication, psychosocial support, school strategies, and parent training.

Medication. Not every child with complex ADHD needs medication, but it can be part of the treatment.

Stimulant medicines like methylphenidate (Concerta, Focalin, Ritalin, and others) and amphetamine (Adderall) may be useful for managing ADHD symptoms such as inattention, hyperactivity, and impulsiveness. These same medicines also treat ODD symptoms. Antidepressants can be part of the treatment for anxiety and depression, along with therapy.

Conditions like autism, anxiety, depression, and tics each have their own set of treatments. These can include a combination of medication and behavior/education strategies.

Psychosocial support. Psychosocial support is a group of treatments that help kids with complex ADHD get along better in their daily life. It includes behavior management, education, and social skills training. The choice of treatments should be based on your child's age, conditions, and stage of development.

Examples of psychosocial support are:

  • Education to help your family and child understand complex ADHD and its treatments.
  • One-on-one sessions with a therapist to teach your child about their moods and behaviors and how to manage them.
  • Training to improve their organizational skills.
  • Support groups where your child can meet other kids with complex ADHD and learn what treatments helped them.
  • Social skills training programs to help your child learn to live more independently, interact with others better, and manage any stresses that come their way.

School strategies. Your child's teachers can reinforce positive behaviors in the classroom by posting rules, rewarding your child for following those rules, and setting consequences for breaking them.

Kids with learning disorders may qualify for special services. Your school can help you set up an Individualized Education Program (IEP) or 504 plan based on the supports your child needs.

Parent training. Parents play an important role in managing complex ADHD. There are some things you can do at home to set your child up for success.

Getting trained in behavior management will better equip you to help your child. This program teaches you the skills and strategies you need to manage problem behaviors at home, in school, and in social settings.

Consistency is important for kids with complex ADHD. That's why these programs will teach you how to set rules and routines. You'll learn to offer positive reinforcements and rewards when your child follows those rules – for example, when they do their chores or get along with their siblings – and how to set firm but fair consequences when they break those rules.

What to Expect

Treating complex ADHD is a long journey. Many kids won't ever grow out of complex ADHD. They'll continue to have mental health, social, and learning challenges as adults, but they can learn how to live with those challenges.

Kids with complex ADHD need careful follow-up throughout their lifetime. Monitoring their progress and adjusting treatment as they grow and move through the different developmental stages will improve their chance of succeeding in school and beyond.

Show Sources

SOURCES:

ADAA: "Treatment."

CDC: "Diagnosing Tic Disorders," "Not Just ADHD? Helping Children With Multiple Concerns," "Parent Training in Behavior Management for ADHD," "Signs and Symptoms of Autism Spectrum Disorder," "What is ADHD?"

CHADD: "Treatment of Complex ADHD."

Child Mind Institute: "Complete Guide to ADHD Medications."

Hopkins Medicine: "Oppositional Defiant Disorder (ODD) in Children."

Journal of Developmental & Behavioral Pediatrics: "Society for Developmental and Behavioral Pediatrics Clinical Guidelines for the Assessment and Treatment of Children and Adolescents With Complex Attention-Deficit/Hyperactivity Disorder."

Lancet Psychiatry: "ADHD in children and young people: prevalence, care pathways, and service provision."

National Alliance on Mental Illness: "Psychosocial Treatments."

Society for Developmental and Behavioral Pediatrics: "Clinical Practice Guidelines For The Assessment and Treatment of Children And Adolescents With Complex Attention-Deficit/Hyperactivity Disorder."

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