When the Labels Don’t Match: Comorbidity in Children’s Mental Health

It is hard to be a parent of a child with mental health challenges, developmental delays, or mood disorders. It is even harder when what you see daily doesn’t line up with any of the doctors’ categories. Kids can be complex. Your child may have more going on than any one condition can describe. In that case you may need to discuss the possibility of comorbidity with your child’s therapist.

What is Comorbidity?

Comorbidity is a medical term meaning two (or more) things happening at once. An adult could have comorbid conditions of obesity and high blood pressure, for example. It also involves how those conditions interact with each other within the patient. For example, obesity can make exercise cause blood pressure to elevate more than in a person with normal weight.

In the mental health world, comorbidity can be especially challenging. Some interactions between mental health disorders can be hard to understand or track. That can make it difficult to properly identify the conditions involved. Children add another level of challenge for parents and therapists. Their brains are changing as they grow up, as is their ability to explain what they are feeling. This creates a moving target for therapists and other treating professionals. As a result, children are often not diagnosed, or misdiagnosed because the adults involved misunderstand the constellation of symptoms they are seeing.

Common Types of Comorbidity in Children’s Mental Health

Many children receive Attention Deficit Disorder (ADD or ADHD with Hyperactivity) as their first mental health diagnosis. However, research now suggests that half of all children with ADHD have a comorbid condition. This can include:

• Depression
• Anxiety
• Obsessive-compulsive disorder (OCD)
• Learning disabilities
• Executive functioning difficulties
• Language disabilities (such as dyslexia)
• Oppositional Defiant Disorder (ODD)

Similarly, nearly three quarters of children with Autism Spectrum Disorder (ASD) have another physical or mental health condition, including:

• Anxiety
• ADHD
• Bipolar disorder
• Depression
• Intellectual disabilities or developmental delays
• Motor difficulties
• Epilepsy
• Sleep disorders

Similarly, a child who has experienced trauma may develop both anxiety and depression in addition to Post Traumatic Stress Disorder (PTSD) or other mental health conditions related to the event.

These comorbid conditions may develop over time. Some may not become apparent until adolescence or even adulthood. In other cases, such as more severe forms of ASD, the underlying condition may mask or interfere with your child’s ability to explain what they are feeling and experiencing. This will prevent doctors and therapists from properly identifying other life-affecting conditions.

What Comorbid Conditions Means for Your Child’s Treatment

Often, each comorbid condition will require separate treatment. Children receiving treatment for one condition may find it lessens some of their symptoms but not others. This can be exhausting for parents, who often feel like there is always another obstacle to overcome in helping their children.

For kids with comorbid conditions, effective treatment requires a careful balance of medication, dietary adjustments, physical activities, psychological therapy and possibly medication. Any change in one of these treatments could influence your child’s other conditions. Children receiving special education at school face another level of complexity. Their aides or special education teachers may be using methods that affect their other conditions without realizing it, especially if the treatment plan is out of date or does not include some of your child’s comorbid conditions.

That is why it is essential that as a parent you keep your therapists, doctors, and educators up to date on all your child’s treatments, therapies, and symptoms. Only by working together, can the adults in your child’s life reach the best outcome and support all your kid’s mental health needs.

David Stanislaw is a psychotherapist with over 30 years of experience. He helps children, teens and adults with complex psychological conditions and comorbidity. Contact David Stanislaw to get help for your child today.