Common Co-Existing Diagnoses

Learning Disabilities and ADHD can coexist with other mental health problems.

Attention Deficit/Hyperactivity Disorder (ADHD) is a highly comorbid condition, meaning it co-occurs with other mental health problems.

  • 87% of children with ADHD have at least one comorbid condition, and 67% of children with ADHD have at least 2 comorbidities.
  • 77% of adults with ADHD have at least one comorbid condition. Comorbidity contributes to the failure to diagnose ADHD in adults.
  • Developmental Coordination Disorder (DCD) co-occurs in approximately 50% of children with ADHD.
  • Oppositional Defiant Disorder (ODD) co-occurs with ADHD in approximately 50% of children with the Combined Presentation, and 25% of children with the Predominately Inattentive Presentation.
  • Conduct Disorder (CD) co-occurs in approximately 25% of adolescents with the Combined Presentation, depending on age and setting.
  • Most children and adolescents with Disruptive Mood Dysregulation Disorder (DMDD) have symptoms that also meet criteria for ADHD, while a lesser percentage of children and adolescents with ADHD have symptoms that also meet criteria for DMDD.
  • Anxiety disorders occur in approximately 25% of individuals with ADHD and mood disorders in approximately 20% of individuals with ADHD, which is more often than in the general population.
  • Other disorders that may co-occur with ADHD include Obsessive-Compulsive Disorder (OCD), Tic Disorders (including Tourette’s syndrome), and Autism Spectrum Disorder (ASD).

LD & ADHD

One of the most common co-existing disorders with LD is ADHD, with as much as 50% of individuals having both LD & ADHD.

ADHD is not a Learning Disability. Each is a distinctively neurologically based disorder. Each is recognized and diagnosed differently and treated in a different way.

Learn more about Learning Disabilities.

Learn more about ADHD.

Developmental Coordination Disorder (DCD)

Developmental Coordination Disorder (DCD) is a motor disorder that impairs everyday fine and/or gross motor movements, such as navigating stairs, getting dressed (e.g., doing up laces), handwriting, and typing. DCD can also impair speech if oral motor functioning is delayed.

Children with DCD are often described as “clumsy” or “awkward” in their motor movements. They commonly bump into things or drop things frequently.

An alternate term for Developmental Coordination Disorder (DCD) is Dyspraxia. Although sometimes considered a “motor-based Learning Disability,” it is a separate disorder.  While 5-6% of children have DCD, 50% of children diagnosed with ADHD are also diagnosed with DCD. It is also common in children with Learning Disabilities and language disorders

A great resource for more information on DCD is www.canchild.ca.

Giftedness

Technically, giftedness isn’t a diagnosis because it isn’t considered a disability. However, some parents may want a psycho-educational assessment for their child if they wonder about giftedness. Within the context of a psycho-educational assessment, giftedness usually requires intelligence test scores that are in the top 2% of the population.

Different school boards and organizations define giftedness in different ways. Knowing whether a child is gifted can be helpful in determining what kinds of educational programming may be beneficial for them.

Twice Exceptional: People who are gifted can also have a diagnosis such as a Learning Disability or ADHD. These people are often referred to as ‘Twice Exceptional’. They can have exceptional ability in one area and struggle in another.

Learn more: Understood.org: The Challenges of Twice Exceptional Kids. Author; Peg Rosen.

Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a Distinct Disorder:

  • While people with Autism Spectrum Disorder (ASD) can have many of the same learning, attention, and social-emotional challenges as those with Learning Disabilities and ADHD, it is a distinct disorder.
  • ASD is a neurodevelopmental disorder where persistent deficits in social communication and social interaction are evident. For example, some individuals with ASD may show a lack of interest in peers and/or struggle with the back-and-forth nature of conversations.
  • In addition, the individual must show restricted, repetitive patterns of behaviour, interests or activities. For example, some individuals with ASD struggle with deviating from a highly structured routine, experience sensitivities to sensory input, and/or have fixated interests.

ASD Diagnosis:

  • Some diagnoses that often co-occur for individuals with ASD include: Learning Disabilities, ADHD, Developmental Coordination Disorder, Intellectual Disabilities, and Language Disorders. Anxiety and depression must also be monitored.
  • If the individual is struggling in social communication and social interactions but is not showing restricted and repetitive behaviour or interests, a diagnosis known as Social (Pragmatic) Communication Disorder may be considered.

For more information on ASD:

Mental Health

Struggling in academic subjects can impact emotions and mental health:

It is important to note that there is a significant interplay between Learning Disabilities, particularly in reading and writing, and behavioural and emotional symptoms, including mood, anxiety, social withdrawal, emotional dysregulation, negative emotionality, low frustration tolerance, aggression, and even serious rule-breaking behaviour.

Difficulties at school or work can significantly impact an individual’s ability to regulate their behaviour and emotions and vice versa. The individual is likely to become easily frustrated and avoidant of undesirable or difficult tasks, which can lead to avoidance (e.g., school refusal).

Feeling unable to meet others’ expectations and feeling powerless to change this can result in feelings of anxiety and depression and behaviours that may be perceived as oppositional (e.g., low frustration tolerance, inappropriate behaviour, noncompliance, poor judgement).

Difficulty processing information may add to emotional stress:

Emotional difficulties may also stem from, and certainly contribute to, a relative weakness in processing information. This would be particularly true within the context of a demanding classroom, workplace, or social situation that requires quick processing and responses. Indeed, in an environment where there are pressures to perform faster or keep up with the group, it would not be unusual for the individual to experience anxiety as a consequence of slow processing speed.

Poor visual perception (i.e., difficulty differentiating and paying close attention to visual information and cues, particularly when feeling pressured or under time constraint), has implications in other areas of functioning other than school achievement. That is, the individual may not pay as close attention to nonverbal communication as needed to be able to interpret the situation accurately and respond in a caring and sensitive manner to others. This may affect social interactions and relationships.

Depression

Anxiety

It is very common for individuals with LD and/or ADHD to develop secondary anxiety and depression due to their lifelong difficulties regulating their behaviour, which impacts their self-confidence. This is because they are more prone to loneliness and low self-esteem. For example, children with LDs are 70% more likely to have heightened anxious symptoms than those without LD.

Excessive Worries

All individuals experience worries and fears, and all people encounter daily stressors. For individuals with LD and/or ADHD, their worries and fears are often about their academic or work struggles, social challenges or emotion and behaviour dysregulation. When the worries impede a person’s day-to-day functioning, then he/she may be experiencing anxiety.

Anxiety Disorders

Anxiety disorders differ from developmentally typical fear (an emotional response to real or perceived threat) or anxiety (worry about a future threat) by being excessive or persisting for a longer than normal amount of time (e.g. typically lasting 6 months or more).

Since individuals with anxiety disorders tend to overestimate the danger in situations they fear or avoid, determining whether the fear or anxiety is excessive or out of proportion is made by a clinician. Many of the anxiety disorders develop in childhood and tend to persist if not treated. Most occur more frequently in females than in males (approximately 2:1 ratio).

Types of Anxiety Disorders:

  • Separation Anxiety
  • Generalized Anxiety Disorder
  • Social Anxiety Disorder
  • Specific Phobia
  • Agoraphobia
  • Panic Disorder-Selective Mutism

Diagnosis & Treatment

For Children, anxiety disorders are best diagnosed by a psychologist, pediatrician, or child psychiatrist.

For Adults, anxiety disorders are best diagnosed by a psychologist, physician or psychiatrist.

Appropriate interventions for anxiety disorders are:

  • Cognitive Behavioural Therapy
  • Family Therapy
  • Executive Function Coaching
  • Yoga
  • Medication

Learn More

Depression

Experiencing sadness is an expected part of child and adulthood. However, when the feelings of sadness are present more often than not and are accompanied by irritable mood, feelings of emptiness, changes in thinking and/or behaviour, then the individual may be experiencing a Depressive Disorder. Up to 20% of individuals with LDs will also have depression.

The common feature of depressive disorders is the presence of sad, empty, or irritable mood accompanied by changes in thinking and somatic (health) complaints. In children, there is often an increase in severe irritability, while in adults there is often a loss of interest or pleasure. How these disorders further differ is by duration, timing and cause. Most occur more frequently in females than in males (approximately 2:1 ratio).

Types of Depressive Disorders

  • Disruptive Mood Regulation Disorder
  • Major Depressive Disorder
  • Persistent Depressive Disorder (Dysthymia)

Diagnosis & Treatment

For Children, diagnoses are best made by a psychologist, pediatrician, child psychiatrist.

For Adults, diagnoses are best made by a psychologist, physician, psychiatrist.

Appropriate interventions for Depressive Disorders are:

  • Therapy
  • Family Therapy
  • Medication

Learn More

Speech & Language

Speech Disorders

  • Speech Disorders are not the same as Language Disorders. A Speech Disorder refers to any condition that affects a person’s ability to produce the sounds that form words.
  • Speech Disorders can affect people of all ages.
  • Common types of Speech Disorders include stuttering, apraxia, and dysarthria.
  • Stuttering refers to interruptions in the flow of speech.
  • Verbal apraxia refers to brain damage that impairs a person’s oral motor skills which affects their ability to form the sounds of speech correctly.
  • Dysarthria occurs when damage to the brain causes muscle weakness in a person’s face, lips, tongue, throat, or chest which can make speaking very difficult.

Language Disorders

  • A Language Disorder can cause issues with understanding and/or using spoken and/or written language.
  • It makes it hard for someone to find the right words, communicate ideas, form clear sentences when speaking, understand what another person says, and organize information that they hear.
  • An individual may have difficulty with receptive language skills (i.e. difficulty understanding what others say, difficulty following simple directions, etc.), expressive language skills (i.e. difficulty sharing thoughts, ideas and feelings, limited vocabulary, etc.), or both.
  • An individual may also have difficulty with pragmatic language skills, which refer to the social language skills that we use in our daily interactions with others. This includes what we say, how we say it, our non-verbal communication (eye contact, facial expressions, body language etc.) and how appropriate our interactions are in a given situation.
  • A language disorder is not the same as a hearing issue or a speech disorder. Individuals with Language Disorders typically have no trouble hearing or pronouncing words. Their challenge is mastering and applying the rules of language, like grammar.
  • Language Disorders can be acquired or developmental.
    • An acquired language disorder, like Aphasia, shows up only after the person has had a neurological illness or injury (e.g. stroke, head injury).
    • A developmental language disorder tends to show up in childhood.
  • About 5% of school-aged children have a Language Disorder.
  • Some research suggests that children with Language Disorders also have problems with reading and writing. In fact, it is not uncommon for children with language and/or speech disorders to be later identified as having a Learning Disability, particularly in the literacy areas.

A great resource is the Alberta College of Speech-Language Pathologists and Audiologists.

LD & Intellectual Disabilities

Intelligence test scores would be lower in a person with an Intellectual Disability as compared to someone with a Learning Disability.

Intellectual Disabilities, as defined by the DSM-5, require three things:

  • Significant challenges in reasoning, problem solving, abstract thinking, and planning, which is measured using an intelligence test.
  • Significant challenges in daily living skills, which include things like communication skills, self-care, managing money, being independent in the community and at home.
  • Evidence that the challenges started when the person was a child.

For more information about Intellectual Disabilities, visit American Association of Intellectual and Developmental Disabilities.

ADHD & Other Conditions

Obsessive-Compulsive Disorder (OCD): Learn more at Alberta OCD Foundation

Tic Disorders (including Tourette’s syndrome): 

Many children may experience tics at some point during their childhood. Tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations. But when these tics become persistent, cannot be resisted, and interfere with functioning, a tic disorder may need to be considered. Approximately 1 in 4 children have some tic disorder, and tic disorders are more common in children with ADHD.

There are two main types of tics: verbal and motor. In each, there are also simple and complex tics.

  • Simple verbal tics include sounds such as grunting, coughing, and throat clearing.
  • Complex verbal tics include words and phrases. While coprolalia, or swearing, is often shown in movies, it is relatively uncommon.
  • Simple motor tics include movements such as blinking and single movements.
  • Complex motor tics include combinations of motor movements. When both multiple motor and vocal tics have been present, a diagnosis of Tourette’s Disorder may be suggested.

For more information on tic disorders, visit Tourette Canada or The Tourette OCD Alberta Network at the University of Calgary.

Oppositional Defiant Disorder (ODD): Children and adolescents with untreated or not adequately treated ADHD often misbehave, not because they are intentionally oppositional, but because of their difficulty remembering rules and inhibiting their responses. They may develop aversion to school or mentally-demanding tasks due to difficulty in sustaining mental effort, forgetting instructions, and impulsivity.

Conduct Disorder (CD): This condition co-occurs in approximately 25% of adolescents with the Combined Presentation, depending on age and setting.

Learn More: Article: Half of All Kids with ADHD Have a Learning Disability or Related Condition. Article by Larry Silver, MD. Published in ADDitude.