Doing a PhD in the subject of ADHD means i have to read a lot of research papers. Every week I read something that makes me more convinced that we are still at the low end of the knowledge curve. The press is telling half the story about ADHD. Most coverage I read is about whether too many people are being diagnosed, or whether medication is handed out too easily. Very little of it mentions what I see in clinic every week: ADHD rarely arrives on its own.
Most of the people I assess carry ADHD alongside at least one other condition. Often it is anxiety, depression, dyslexia, autism or a sleep problem. These conditions shape how ADHD feels, how it is diagnosed and how it should be treated. Leave them out, and the public picture of ADHD is not just incomplete. It is misleading.
Comorbidity is the rule, not the exception
Between 60% and 90% of children with ADHD, and up to 80% of adults, have at least one coexisting condition (Creyos). Clinicians call these “comorbid” or “co-occurring” conditions.
Put simply, a person with ADHD and nothing else is the unusual case. Yet public debate tends to treat ADHD as a single, separate thing that someone either has or does not have.
In children
For children, the most common companions are learning difficulties and behavioural conditions. Anxiety and autism are also common.
| Condition | Children with ADHD affected | What it looks like |
|---|---|---|
| Learning disabilities | About 20% to 60% | Dyslexia (reading and spelling), dyscalculia (maths), dysgraphia (writing) |
| Oppositional defiant disorder (ODD) | About 30% to 50% | Ongoing defiance and anger-driven behaviour |
| Conduct disorder | About 27% | Persistent rule-breaking or aggression |
| Anxiety disorders | About 18% to 35% | Worry, fear and avoidance |
| Autism | Frequent overlap | Differences in social communication and behaviour |
| Tic disorders and Tourette syndrome | A significant portion | More than half of children with Tourette’s also have ADHD |
Sources: CHADD, Creyos, PMC6745333, Open University, ADHD Centre.
A child who is struggling at school, refusing instructions and anxious may be carrying three conditions, not one. Each needs to be seen.
In adults
In adults, the picture shifts towards anxiety, mood, substance use and physical health. Many of the adults I see have spent decades being treated for these conditions without anyone noticing the ADHD underneath.
| Condition | Adults with ADHD affected | Notes |
|---|---|---|
| Anxiety disorders | About 47% to 50% | Includes social anxiety |
| Major depression | About 12% to 50% | Wide range across studies |
| Bipolar disorder | Up to 20% | Needs careful assessment, as symptoms overlap |
| Substance use disorders | About 15% to 39% | Linked to self-medication and impulsivity |
| Sleep disorders | Very common | Delayed body clock and racing thoughts |
| Obesity and metabolic problems | Higher than average | Seen in both children and adults |
Sources: ADAA, Medizinonline, CHADD, PMC6745333, Creyos, ADHD Centre.
Why this matters in the clinic
Comorbidity changes both diagnosis and treatment. That is why a good ADHD assessment takes time.
Diagnosis. Poor concentration, restlessness and emotional dysregulation appear in many conditions, not just ADHD. A careful assessment has to separate core ADHD from what sits alongside it. Structured screening and objective tools help with this (Creyos).
Treatment order. Clinicians generally treat whatever is causing the most immediate harm first. Severe substance use or bipolar mania, for example, would be stabilised before ADHD treatment begins (PMC5567978, ADAA).
When the press treats a quick diagnosis as the problem, it misses the point. The real risk is an assessment that sees only ADHD, or only the anxiety, and never the whole person.
My research: shame is the thread
My doctoral research at Northumbria University looks at ADHD and shame. I believe shame is one of the threads that ties ADHD to so many of these other conditions.
Think about what a person with ADHD often hears growing up. “You’re lazy.” “You’re not trying.” “Why can’t you just…?” Over years, those messages can settle into a deep, lasting sense of being flawed. In my clinical work, I see that chronic shame sitting underneath anxiety, low mood, avoidance and, for some people, drinking or drug use.
I work as a Cognitive Analytic Therapist. In CAT, we look at the patterns people learn in relationships, including the relationship they have with themselves. With ADHD, a common pattern is shaming and shamed, or critical and criticised. The person learns to criticise themselves before anyone else can.
My study is a feasibility study. It asks whether a brief, 8-session course of CAT is feasible and acceptable for adults with ADHD. It does not yet ask whether it works. That comes later. But first we need to know if this kind of therapy fits people’s lives and needs.
My hope is that by working with shame directly, we can reach some of the distress that sits across ADHD and its companion conditions, rather than treating each one in isolation.
What the press is missing
The current headlines about ADHD focus on numbers: waiting lists, prescriptions and overdiagnosis. Those are fair questions to ask. But the coverage almost never asks what else these people are living with.
That silence has a cost. People with ADHD already worry about being judged. Many of the people I see are frightened that they will be dismissed as a trend, or as someone chasing a label. When the public story leaves out the anxiety, depression, learning difficulties and sleep problems that so often come with ADHD, it adds to the very shame my research is trying to address.
I would like to see journalists ask different questions:
- What other conditions does this person live with?
- How long were those conditions treated before anyone spotted the ADHD?
- What does good, joined-up assessment actually look like?
ADHD rarely travels alone. It is time the way we write about it reflected that.
Stephen Taylor is an Advanced Nurse Practitioner, Independent Prescriber and Cognitive Analytic Therapist, and the founder of The ADHD Specialists. He is a doctoral researcher at Northumbria University.