Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Medical conditions and Attention-Deficit/Hyperactivity Disorder symptoms from early childhood to adolescence

Molecular Psychiatry volume 27, pages 976–984 (2022)Cite this article

Subjects

Abstract

The comorbidity between physical and mental health conditions is challenging and frequently goes unrecognized in practice. Associations between Attention-Deficit/Hyperactivity Disorder (ADHD) and physical conditions have been reported in youth. However, prior research failed to: (1) address the patterns of associations in early childhood, middle childhood, and adolescence within the same population sample; (2) consider a large set of physical disorders at the same time; (3) take confounders into account. Our goal was to assess the associations between ADHD symptoms and a broad set of physical conditions across developmental periods. This birth cohort study (n = 2057) is the first to explore the associations between ADHD and a wide range of medical conditions by encompassing the whole early development from 5 months to 17 years in the same sample and relying on innovative network analyses. We found significant associations between ADHD symptoms and several physical conditions, some of which were observed in early childhood, middle childhood, and adolescence (e.g., asthma, sleep problems) or were confounded by socioeconomic status or psychiatric comorbidities (e.g., body mass index, dental caries). The study calls for an effective integrated care model encompassing mental and general healthcare across the developmental period.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Network displaying relationship between medical conditions and ADHD symptoms z-scores measured during early childhood, middle childhood, and adolescence.

Similar content being viewed by others

References

  1. Momen NC, Plana-Ripoll O, Agerbo E, Benros ME, Børglum AD, Christensen MK, et al. Association between mental disorders and subsequent medical conditions. N Engl J Med. 2020;382:1721–31.

    Article  PubMed  PubMed Central  Google Scholar 

  2. DE Hert M, Correll CU, Bobes, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10:52–77.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dayan CM, Panicker V. Hypothyroidism and depression. Eur Thyroid J. 2013;2:168–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Chen MH, Wei HT, Bai YM, Huang KL, Ko NY, Su TP, et al. Sexually transmitted infection among adolescents and young adults with bipolar disorder: a nationwide longitudinal study. J Clin Psychiatry. 2019;80:18m12199.

    Article  PubMed  Google Scholar 

  5. Druss BG, Walker ER. Mental disorders and medical comorbidity. Synth Proj Res Synth Rep. 2011;21:1–26.

    Google Scholar 

  6. Brainstorm consortium. Analysis of shared heritability in common disorders of the brain. Science. 2018;360:eaap8757.

    Article  CAS  Google Scholar 

  7. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43:434–42.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994–1001.

    Article  PubMed  Google Scholar 

  9. Doshi JA, Hodgkins P, Kahle J, Sikirica V, Cangelosi MJ, Setyawan J, et al. Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. J Am Acad Child Adolesc Psychiatry. 2012;51:990–1002.e2.

    Article  PubMed  Google Scholar 

  10. Holden SE, Jenkins-Jones S, Poole CD, Morgan CL, Coghill D, Currie CJ. The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child Adolesc Psychiatry Ment Health. 2013;7:34.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schatz DB, Rostain AL. ADHD with comorbid anxiety: a review of the current literature. J Atten Disord. 2006;10:141–9.

    Article  PubMed  Google Scholar 

  12. Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry. 2009;48:894–908.

    PubMed  Google Scholar 

  13. Cortese S, Moreira-Maia CR, St. Fleur D, Morcillo-Peñalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry. 2016;173:34–43.

    Article  PubMed  Google Scholar 

  14. Nigg JT, Johnstone JM, Musser ED, Long HG, Willoughby MT, Shannon J. Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: new data and meta-analysis. Clin Psychol Rev. 2016;43:67–79.

    Article  PubMed  Google Scholar 

  15. Chen Q, Hartman CA, Haavik J, Harro J, Klungsøyr K, Hegvik TA, et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: a population-based cross-sectional study. PLoS ONE. 2018;13:e0204516.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Cortese S, Sun S, Zhang J, Sharma E, Chang Z, Kuja-Halkola R, et al. Association between attention deficit hyperactivity disorder and asthma: a systematic review and meta-analysis and a Swedish population-based study. Lancet Psychiatry. 2018;5:717–26.

    Article  PubMed  Google Scholar 

  17. Schans J, van der, Çiçek R, de Vries TW, Hak E, Hoekstra PJ. Association of atopic diseases and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. Neurosci Biobehav Rev. 2017;74:139–48.

    Article  PubMed  Google Scholar 

  18. Kase BE, Rommelse N, Chen Q, Li L, Andersson A, Du Rietz E, et al. Longitudinal associations between symptoms of ADHD and BMI from late childhood to early adulthood. Pediatrics. 2021;147:e2020036657.

    Article  PubMed  Google Scholar 

  19. Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5:727–38.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cortese S, Castellanos FX. The relationship between ADHD and obesity: implications for therapy. Expert Rev Neurother. 2014;14:473–9.

    Article  CAS  PubMed  Google Scholar 

  21. Cortese S. The association between ADHD and obesity: intriguing, progressively more investigated, but still puzzling. Brain Sci. 2019;9:256.

    Article  PubMed Central  Google Scholar 

  22. Orri M, Boivin M, Chen C, Ahun MN, Geoffroy M-C, Ouellet-Morin I, et al. Cohort profile: quebec longitudinal study of child development (QLSCD). Soc Psychiatry Psychiatr Epidemiol. 2021;56:883–94.

    Article  PubMed  Google Scholar 

  23. Statistics Canada. Longitudinal Survey of Children and Youth (NLSCY). 14 mai 2009; Disponible sur. http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=4450.

  24. Achenbach TM, Edelbrock C, Howell CT. Empirically based assessment of the behavioral/emotional problems of 2- and 3- year-old children. J Abnorm Child Psychol. 1987;15:629–50.

    Article  CAS  PubMed  Google Scholar 

  25. Offord DR, Boyle MH, Racine Y. Ontario Child Health Study: correlates of disorder. J Am Acad Child Adolesc Psychiatry. 1989;28:856–60.

    Article  CAS  PubMed  Google Scholar 

  26. Tremblay RE, Desmarais-Gervais L, Gagnon C, Charlebois P. The Preschool Behaviour Questionnaire: stability of its factor structure between cultures, sexes, ages and socioeconomic classes. Int J Behav Dev. 1987;10:467–84.

    Article  Google Scholar 

  27. Côté SM, Orri M, Brendgen M, Vitaro F, Boivin M, Japel C, et al. Psychometric properties of the Mental Health and Social Inadaptation Assessment for Adolescents (MIA) in a population-based sample. Int J Methods Psychiatr Res. 2017;26:e1566.

    Article  PubMed Central  Google Scholar 

  28. Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6.

    Article  CAS  PubMed  Google Scholar 

  29. Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Prim. 2015;1:15020.

    Article  PubMed  Google Scholar 

  30. Galéra C, Côté SM, Bouvard MP, Pingault JB, Melchior M, Michel G, et al. Early risk factors for hyperactivity-impulsivity and inattention trajectories from age 17 months to 8 years. Arch Gen Psychiatry. 2011;68:1267–75.

    Article  PubMed  Google Scholar 

  31. Romano E, Tremblay RE, Farhat A, Côté S. Development and prediction of hyperactive symptoms from 2 to 7 years in a population-based sample. Pediatrics. 2006;117:2101–10.

    Article  PubMed  Google Scholar 

  32. Vergunst F, Tremblay RE, Galera C, Nagin D, Vitaro F, Boivin M, et al. Multi-rater developmental trajectories of hyperactivity–impulsivity and inattention symptoms from 1.5 to 17 years: a population-based birth cohort study. Eur Child Adolesc Psychiatry. 2019;28:973–83.

    Article  PubMed  Google Scholar 

  33. Leblanc N, Boivin M, Dionne G, Brendgen M, Vitaro F, Tremblay RE, et al. The development of hyperactive-impulsive behaviors during the preschool years: the predictive validity of parental assessments. J Abnorm Child Psychol. 2008;36:977–87.

    Article  PubMed  Google Scholar 

  34. Statistics Canada. Overview of survey instruments for 1994-1995 data collection, cycle 1. Ottawa, ON: Statistics Canada; 1995.

  35. Radloff LS. The CESD-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  36. Haslbeck JMB, Waldorp LJ. How well do network models predict observations? On the importance of predictability in network models. Behav Res Methods. 2018;50:853–61.

    Article  PubMed  Google Scholar 

  37. Efron B. Bayesian inference and the parametric bootstrap. Ann Appl Stat. 2012;6:1971–97.

    Article  PubMed  PubMed Central  Google Scholar 

  38. VanderWeele TJ. Principles of confounder selection. Eur J Epidemiol. 2019;34:211–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Angriman M, Cortese S, Bruni O. Somatic and neuropsychiatric comorbidities in pediatric restless legs syndrome: a systematic review of the literature. Sleep Med Rev. 2017;34:34–45.

    Article  PubMed  Google Scholar 

  40. Auvin S, Wirrell E, Donald KA, Berl M, Hartmann H, Valente KD, et al. Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia. 2018;59:1867–80.

    Article  PubMed  Google Scholar 

  41. Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, et al. Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2018;84:63–71.

    Article  PubMed  Google Scholar 

  42. Muskens JB, Velders FP, Staal WG. Medical comorbidities in children and adolescents with autism spectrum disorders and attention deficit hyperactivity disorders: a systematic review. Eur Child Adolesc Psychiatry. 2017;26:1093–103.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Buske-Kirschbaum A, Trikojat K, Tesch F, Schmitt J, Roessner V, Luksch H, et al. Altered hypothalamus-pituitary-adrenal axis function: a relevant factor in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder? Psychoneuroendocrinology 2019;105:178–86.

    Article  CAS  PubMed  Google Scholar 

  44. Trikojat K, Buske-Kirschbaum A, Schmitt J, Plessow F. Altered performance in attention tasks in patients with seasonal allergic rhinitis: seasonal dependency and association with disease characteristics. Psychol Med. 2015;45:1289–99.

    Article  CAS  PubMed  Google Scholar 

  45. Swanson JM, Volkow ND. Lessons from the 1918 flu pandemic: a novel etiologic subtype of ADHD? J Am Acad Child Adolesc Psychiatry. 2021;60:1–2.

    Article  PubMed  Google Scholar 

  46. Brikell I, Ghirardi L, D’Onofrio BM, Dunn DW, Almqvist C, Dalsgaard S, et al. Familial liability to epilepsy and Attention-Deficit/Hyperactivity Disorder: a nationwide cohort study. Biol Psychiatry. 2018;83:173–80.

    Article  PubMed  Google Scholar 

  47. Chau YCY, Peng S-M, McGrath CPJ, Yiu CKY. Oral health of children with attention deficit hyperactivity disorder: systematic review and meta-analysis. J Atten Disord. 2017;1087054717743331.

  48. Kerr DCR, Lunkenheimer ES, Olson SL. Assessment of child problem behaviors by multiple informants: a longitudinal study from preschool to school entry. J Child Psychol Psychiatry. 2007;48:967–75.

    Article  PubMed  Google Scholar 

  49. Green JG, DeYoung G, Wogan ME, Wolf EJ, Lane KL, Adler LA. Evidence for the reliability and preliminary validity of the Adult ADHD Self-Report Scale v1.1 (ASRS v1.1) Screener in an adolescent community sample. Int J Methods Psychiatr Res. 2019;28:e1751.

    Article  PubMed  Google Scholar 

  50. Salbach-Andrae H, Klinkowski N, Lenz K, Lehmkuhl U. Agreement between youth-reported and parent-reported psychopathology in a referred sample. Eur Child Adolesc Psychiatry. 2009;18:136–43.

    Article  PubMed  Google Scholar 

  51. Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry. 2013;54:227–46.

    Article  PubMed  Google Scholar 

Download references

Author contributions

CG and SC contributed to the literature search, data analysis, data interpretation, and writing. MO, JvDW, and MM contributed to the data interpretation and writing. OC contributed to the data analysis, data interpretation, and writing. MB, SMC, and RET contributed to the study design, data collection, data interpretation, and writing. SMC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

The larger Québec Longitudinal Study of Child Development was supported by the Québec Government’s Ministry of Health, Ministry of Education, and Ministry of Family Affairs, The Lucie and André Chagnon Foundation, the Robert-Sauvé Research Institute of Health and Safety at Work, and the Québec Statistics Institute. Additional funding was received from the Fonds de Recherche du Québec–Santé, the Fonds de Recherche du Québec–Societé et Culture, Canada’s Social Science and Humanities Research Council, the Canadian Institutes of Health Research, the St. Justine Research Center, and the French National Research Agency (ANR).

Author information

Author notes

  1. These authors contributed equally: Cédric Galéra, Samuele Cortese.

Authors and Affiliations

  1. University of Bordeaux, Bordeaux, France

    Cédric Galéra

  2. INSERM, Bordeaux Population Health Center, UMR1219, Bordeaux, France

    Cédric Galéra, Massimiliano Orri & Sylvana M. Côté

  3. Centre Hospitalier Perrens, Bordeaux, France

    Cédric Galéra

  4. Research Unit on Children’s Psychosocial Maladjustment, Montreal, QC, Canada

    Cédric Galéra, Michel Boivin, Richard E. Tremblay & Sylvana M. Côté

  5. University of Southampton, Solent NHS Trust, Southampton, UK

    Samuele Cortese

  6. University of Nottingham, Nottingham, UK

    Samuele Cortese

  7. Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA

    Samuele Cortese

  8. McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada

    Massimiliano Orri

  9. School of Public Health, University of Montréal, Montréal, QC, Canada

    Ophélie Collet

  10. INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France

    Judith van der Waerden & Maria Melchior

  11. School of Psychology, Université Laval, Quebec, QC, Canada

    Michel Boivin

  12. Department of Psychology, University of Montreal, Montreal, QC, Canada

    Richard E. Tremblay

  13. CHU Ste-Justine Research Centre, Montreal, QC, Canada

    Richard E. Tremblay & Sylvana M. Côté

  14. Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada

    Sylvana M. Côté

Authors
  1. Cédric Galéra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuele Cortese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Massimiliano Orri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ophélie Collet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Judith van der Waerden
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Melchior
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michel Boivin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Richard E. Tremblay
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sylvana M. Côté
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cédric Galéra.

Ethics declarations

Competing interests

MB and RT report holding a Canada Research Chair in Child Development funded by the CIHR. SC reports being a research fellow of the Fonds de Recherche du Québec. RT reports being funded by the Canadian Institute of Advanced Research. SC reports funding from the National Institute of Health Research (NIHR). All other authors declare no competing interests.

Patient and public involvement

Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galéra, C., Cortese, S., Orri, M. et al. Medical conditions and Attention-Deficit/Hyperactivity Disorder symptoms from early childhood to adolescence. Mol Psychiatry 27, 976–984 (2022). https://doi.org/10.1038/s41380-021-01357-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41380-021-01357-x

This article is cited by

Search

Advanced search

Quick links