Introduction: What is comorbidity?
You’ve probably heard of the terms ‘ADHD’, ‘autism’ and ‘dyslexia’ before, but the term ‘comorbidity’ remains unfamiliar to many, much less in the world of neurodivergence. Comorbidity means having 2 or more medical conditions at the same time. These conditions may interact and influence each other, and have overlapping risk factors, but they can also exist separately. They do not directly cause the presence of other medical conditions.[1] In terms of neurodivergence, comorbidity can occur at a very high rate. If someone has a neurodivergent condition, they are more likely to have at least one other condition. [2] This intricate relationship of the human brain will be explored in this issue.
Article 1:
Title: Comorbidity in reality
Those familiar with neurodivergence should know, ADHD, ASD and other neurodiverse conditions often come as a package. But how many can say that they truly understand the factors and significance behind the topic of comorbidity?
The lifetime prevalence of any disorder has been reported to be 46.4%, while the lifetime prevalence of 2 and 3 disorders were found to be 27.7% and 17.3%, respectively[3]. In the context of neurodivergence, those with Dyslexia and Attention Deficit Hyperactivity Disorder (ADHD) have a higher comorbidity rate, while people with Autistic Spectrum Condition(ASC) are at higher risk for mental health conditions[4].
Did you know that approximately 1 in 2 people with ADHD have dyslexia, and that 9 in 10 people with Tourette’s have ADHD[5]? Statistics also reveal that it is common for neurodevelopmental conditions to occur with co-occurring mental health conditions[6]. Such comorbidity can occur for a variety of reasons. It may be a chance occurrence or it may have developed due to overlapping risk factors[7]. An example would be how both ADHD and ASD have common features like sensory sensitivities, social communication challenges and executive functioning challenges. Recognising the various overlapping risk factors is vital for tailored interventions and support strategies. It allows parents to better understand their child’s needs and ensures that none of their needs get ignored.
Looking at the comorbidity of two or more learning disabilities from a neurobiological perspective, genetic predispositions, neurotransmitter dysregulation, and hormonal influences, just to name a few, all play a notable role in comorbid disorders. These many factors would explain why comorbidity is such a common occurrence.
Therefore, there is a pressing need to spread awareness for more targeted healthcare approaches, such that diagnosis and treatment strategies can be further improved.
Comorbidity can make proper diagnosis and treatment harder, as one condition may mask or suppress symptoms of another. Oftentimes, an individual may be misdiagnosed or only diagnosed with one condition. When dealing with comorbidity, it can be useful to seek help from professionals that have experience in dealing with similar cases of comorbid conditions. It is especially important to know if there is a second co-occuring condition because it can affect treatment of the existing diagnosis. For example, medications for a certain condition can have adverse effects on a patient who also suffers from another condition.
It is prudent to keep an eye out for common comorbid conditions, to prevent the development of secondary mental health issues like depression and anxiety. Being familiar with the signs and symptoms of other disorders that present similarly can also help to prevent a misdiagnosis.
All in all, learning disabilities like ADHD and dyslexia often co-occur alongside other conditions and mental health issues, which can make diagnosis and treatment a bit harder. Knowing more about said conditions can help us learn to adapt and receive better treatment in the long run.
Source: https://www.additudemag.com/mental-health-diagnosis-adhd-comorbidities/
Article 2:
Title: Neurodivergence and mental illness are inextricable – Or are they?
In and of itself, comorbidity in those neurodivergent is not an unusual occurrence. Our above article on the neurobiology of comorbidity extensively delves into the overlapping risk factors that cause neurodiverse conditions to manifest together. The issue at hand then, is why clinical depression is present in approximately 50% of children on the autism spectrum, 19-53% of those with ADHD, and why the majority of the neurodivergent population suffer from anxiety disorders among other mental health conditions. [1]
Autism and ADHD are both linked with higher rates of depression, anxiety, substance abuse disorder (SUD), bipolar disorder, obsessive compulsive disorder (OCD), eating disorders, personality disorders, and more – They are often comorbid. [2] While characteristics of autism and ADHD can be distressing and difficult to manage, resulting in negatively affected mental health, this hints at a much more complex social issue that must be addressed for the betterment of all those neurodivergent.
So what then, is the root of the profound connection between mental health and neurodiverse conditions? It all comes back to social stigma. External, systemic factors that are out of the neurodiverse individual’s control. [3]
Firstly, for as long as there has been neurodivergence, there has been stigma attached to it. In schools, children are often isolated and ostracised by their neurotypical peers for their different needs, and even by teachers who may be unable to identify the different neurotypes present in their students. For instance, children with ADHD may be thought to have attitude and behavioural issues, that “they are not applying themselves”, and are hence dealt unnecessary disciplinary punishments. While it is not completely the fault of educators who fail to understand the needs of children with a different neurotype, it is evident that misleading information and the lack therefore results in neurodivergent children not receiving the help they need. Furthermore, when these children are faced with ostracization, when they are told by adult figures that there is something wrong with them, when they don’t know what is wrong with them, it is inevitable that they feel ashamed of themselves and try to hide their condition to appear “normal”. This is called masking – an act linked with higher levels of depression. [1]
Secondly, in a similar vein, lack of education and stigma from mental health professionals is also a potential barrier to accessing treatment.
Many mental illnesses share symptoms with autism and ADHD, and thus may be hard to differentiate, leading to misdiagnosis or patients not being diagnosed at all, and them not receiving the type of support they need. [4] Additionally, many healthcare professionals are unfamiliar with the complexities of neurodivergence, and may be unwilling to expand their field of vision due to the stigma associated with such individuals. This is especially an issue for comorbid ADHD and depression, with one study finding that 34% of a cohort of patients with treatment resistant depression had undiagnosed ADHD. [1]
With the blind eye much of society has turned to neurodivergent individuals, it should not come as a surprise that such a large proportion of the population struggle with comorbid mental illnesses.
Article 3: Twice exceptional children
Twice exceptional, or “2e”, refers to children who are gifted intellectually, and suffer from one or more learning or developmental disabilities.
Twice exceptional children think and interact with the world differently compared to other children, both due to their giftedness and their disability. They may have exceptional talent in areas such as math or science, language or music, and yet struggle more than other children with certain tasks.
It may be harder to detect a learning disability in a twice-exceptional child. Symptoms of their disability may be masked by their strengths, causing them to be overlooked by teachers and professionals. They may also face difficulties in school. For example, a gifted child with dyslexia may be able to use inference and deductive reasoning skills to fill in words that they are unable to decode when reading. In this way, the child manages to compensate for their reading disability, and avoids detection. The child may only be diagnosed later on, when the curriculum becomes more challenging; or they may never receive a diagnosis.
Being gifted can also increase the likelihood of a misdiagnosis. Many common traits and characteristics of giftedness overlap signs of neurodivergence. For example, gifted children are more sensitive to external stimuli, such as sounds and smells; they also tend to have an intense interest in certain areas, and prefer playing by themselves. These are also traits typically found in individuals with aspergers, or Autism Spectrum Disorder. As such, 2e children may remain undetected for a long time.
Twice exceptional children may also struggle more emotionally, with emotional dysregulation, elevated frustration or anxiety. This is due to the fact that they often do not understand what makes them different from their peers, and are frustrated with themselves for not being able to accomplish certain tasks. They are also at higher risk of being bullied. With undiagnosed individuals, teachers and parents may write off their behaviour as being ‘lazy’ or intentionally defiant, which can adversely affect their self-esteem and mental health. As such, many 2e children wind up feeling “stupid” and hating or avoiding school.
Twice exceptional children often display certain characteristics. These include:
- Adept ability to problem-solve and think critically
- Greater sensitivity to stimuli around them
- Negative self image due to seeking perfection
- Struggling with social cues
- Ability to concentrate intensely on areas of interest
- Difficulties reading and/or writing
- Behavioural problems due to high levels of stress or boredom
Due to these specific strengths and weaknesses, 2e kids benefit from a learning environment that is customised to their needs. They would be adequately challenged in school, while still receiving the necessary support. While it may not be easy to specially customise the school curriculum for the child, there are numerous afterschool programs that cater to gifted children which can help them develop in the areas of their interest. Schools can also offer help through Access Arrangements such as extra time in exams, and additional support during classtime.
Understanding your 2e child’s strengths and weaknesses is the key to helping them maximise their potential.
https://www.davidsongifted.org/gifted-blog/twice-exceptional-definition-characteristics-identification/
https://childmind.org/article/twice-exceptional-kids-both-gifted-and-challenged/
Book recommendation:
Percy Jackson and the Lightning Thief by Rick Riordan
Percy Jackson and the Lightning Thief is the first book in the Percy Jackson series that follows Percy, a demigod and son of the Greek god Poseidon, as embarks on quests with other demigods to save the world. Percy, like all demigods, has ADHD because of his natural battlefield reflexes, and dyslexia because he is hardwired to read Ancient Greek. The character and stories of Percy Jackson were conceptualised when Rick Riordan started inventing stories for his son Haley Riordan, who was diagnosed with ADHD and dyslexia. This book offers a powerful narrative of a boy with neurodivergent comorbidity who is able to become a brave hero and triumph in the face of challenges.
CATCHWISE LEARNING