Skip to main content
SpringerLink
Log in

Chronic conditions and coexisting ADHD—a complicated combination in adolescents

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Adolescents with chronic conditions (CCs) take more health risks than peers. However, coexisting ADHD has not sufficiently been considered. The aim of the present study was to investigate the impact of different CCs on protective factors and health-risk behaviors, taking coexisting ADHD into account. A school-based study among 6895 15- and 17-year-old students was performed in the county of Sörmland, Sweden in 2011 (response rate 80 %). The questionnaire explored background factors, CCs, protective factors, and health-risk behaviors. CCs were reported by 11 %, while 55 % were healthy. Students with CCs more often reported coexisting ADHD than healthy students. In adolescents with neurological conditions, the odds ratio for having ADHD was 7.34 (95 % CI 3.00–17.99) as compared to healthy peers. Few protective factors (<4) and clustered health-risk behaviors (≥4) were more common among students with CCs, especially if ADHD or a combination including ADHD was reported.

Conclusion: CCs and coexisting ADHD are associated with few protective factors and clustered-health risk behaviors. Adolescents with ADHD—in addition to a chronic condition—should be specially acknowledged by health care professionals in order to prevent health risk behaviors. ADHD should be considered when studying these outcomes in adolescents.

What is Known:

• Youth with chronic conditions (CCs)—especially ADHD—are reported to take more health risks than peers.

• In earlier studies of youth with CCs, the presence of coexisting ADHD has not been taken into account.

What is New:

• In this study, we showed that ADHD was more prevalent among adolescents with different types of CCs.

• CCs and coexisting ADHD were associated with few protective factors and clustered health-risk behaviors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ADHD:

Attention deficit hyperactivity disorder

CCs:

Chronic conditions

References

  1. (2002) Mis. Meddelanden i samordningsfrågor för Sveriges officiella statistik (Print). Statistiska centralbyrån (Statistics Sweden) (SCB), Stockholm

  2. (2014) Landstinget Sörmland, Liv och Hälsa Ung 2011 (available from http://www.landstingetsormland.se/Utveckling-forskning/Folkhalsodata/Liv-och-halsa-ung/Enkater/)

  3. Annerback EM, Sahlqvist L, Svedin CG, Wingren G, Gustafsson PA (2012) Child physical abuse and concurrence of other types of child abuse in Sweden-Associations with health and risk behaviors. Child Abuse Negl 36:585–595

    Article  PubMed  Google Scholar 

  4. Annerback EM, Sahlqvist L, Wingren G (2013) A cross-sectional study of victimisation of bullying among schoolchildren in Sweden: background factors and self-reported health complaints. Scand J Public Health

  5. Annerback EM, Wingren G, Svedin CG, Gustafsson PA (2010) Prevalence and characteristics of child physical abuse in Sweden—findings from a population-based youth survey. Acta Paediatr (Oslo, Norway: 1992) 99:1229–1236

    Article  Google Scholar 

  6. Barkley RA Attention-deficit hyperactivity disorder

  7. Bernat DH, Oakes JM, Pettingell SL, Resnick M (2012) Risk and direct protective factors for youth violence: results from the National Longitudinal Study of Adolescent Health. Am J Prev Med 43:S57–66

    Article  PubMed  Google Scholar 

  8. Blackman JA, Conaway MR (2013) Developmental, emotional and behavioral co-morbidities across the chronic health condition spectrum. J Pediatr Rehabil Med 6:63–71

    PubMed  Google Scholar 

  9. Blum RW, Kelly A, Ireland M (2001) Health-risk behaviors and protective factors among adolescents with mobility impairments and learning and emotional disabilities. J Adolesc Health 28:481–490

    Article  CAS  PubMed  Google Scholar 

  10. Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, Chen TJ, Bai YM (2013) Asthma and attention-deficit/hyperactivity disorder: a nationwide population-based prospective cohort study. J Child Psychol Psychiatry 54:1208–1214

    Article  PubMed  Google Scholar 

  11. Coie JD, Watt NF, West SG, Hawkins JD, Asarnow JR, Markman HJ, Ramey SL, Shure MB, Long B (1993) The science of prevention. A conceptual framework and some directions for a national research program. Am Psychol 48:1013–1022

    Article  CAS  PubMed  Google Scholar 

  12. Cortese S (2012) The neurobiology and genetics of attention-deficit/hyperactivity disorder (ADHD): what every clinician should know. EJPN Off J Eur Paediatr Neurol Soc 16:422–433

    Article  Google Scholar 

  13. Delamater AM (2009) Psychological care of children and adolescents with diabetes. Pediatr Diabetes 10(Suppl 12):175–184

    Article  PubMed  Google Scholar 

  14. Denney CB (2001) Stimulant effects in attention deficit hyperactivity disorder: theoretical and empirical issues. J Clin Child Psychol 30:98–109

    Article  CAS  PubMed  Google Scholar 

  15. Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2:104–113

    PubMed Central  PubMed  Google Scholar 

  16. Ginsberg Y, Hirvikoski T, Lindefors N (2010) Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry 10:112

    Article  PubMed Central  PubMed  Google Scholar 

  17. Groenman AP, Oosterlaan J, Rommelse NN, Franke B, Greven CU, Hoekstra PJ, Hartman CA, Luman M, Roeyers H, Oades RD, Sergeant JA, Buitelaar JK, Faraone SV (2013) Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. Br J Psychiatry J Ment Sci 203:112–119

    Article  Google Scholar 

  18. Hatzmann J, Peek N, Heymans H, Maurice-Stam H, Grootenhuis M (2014) Consequences of caring for a child with a chronic disease: employment and leisure time of parents. J Child Health Care 18:346–57

    Article  PubMed  Google Scholar 

  19. Jessor R (1991) Risk behavior in adolescence: a psychosocial framework for understanding and action. J Adolesc Health 12:597–605

    Article  CAS  PubMed  Google Scholar 

  20. Kim GH, Kim JY, Byeon JH, Eun BL, Rhie YJ, Seo WH, Eun SH (2012) Attention deficit hyperactivity disorder in epileptic children. J Korean Med Sci 27:1229–1232

    Article  PubMed Central  PubMed  Google Scholar 

  21. Lee SS, Humphreys KL, Flory K, Liu R, Glass K (2011) Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev 31:328–341

    Article  PubMed Central  PubMed  Google Scholar 

  22. Mogensen N, Larsson H, Lundholm C, Almqvist C (2011) Association between childhood asthma and ADHD symptoms in adolescence—a prospective population-based twin study. Allergy 66:1224–1230

    Article  CAS  PubMed  Google Scholar 

  23. Murphy KR, Barkley RA Parents of children with attention-deficit/hyperactivity disorder: psychological and attentional impairment

  24. Nylander C, Seidel C, Tindberg Y (2013) The triply troubled teenager—chronic conditions associated with fewer protective factors and clustered risk behaviours. Acta Paediatr 103:194–200

    Article  PubMed  Google Scholar 

  25. Nylander C, Toivonen H, Nasic S, Soderstrom U, Tindberg Y, Fernell E (2013) Children and adolescents with type 1 diabetes and high HbA1c—a neurodevelopmental perspective. Acta Paediatr 102:410–415

    Article  PubMed  Google Scholar 

  26. Patterson J, Blum RW (1996) Risk and resilience among children and youth with disabilities. Arch Pediatr Adolesc Med 150:692–698

    Article  CAS  PubMed  Google Scholar 

  27. Patton GC, Tollit MM, Romaniuk H, Spence SH, Sheffield J, Sawyer MG (2011) A prospective study of the effects of optimism on adolescent health risks. Pediatrics 127:308–316

    Article  PubMed  Google Scholar 

  28. Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, Tabor J, Beuhring T, Sieving RE, Shew M, Ireland M, Bearinger LH, Udry JR (1997) Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 278:823–832

    Article  CAS  PubMed  Google Scholar 

  29. Sawyer SM, Drew S, Yeo MS, Britto MT (2007) Adolescents with a chronic condition: challenges living, challenges treating. Lancet 369:1481–1489

    Article  PubMed  Google Scholar 

  30. Seidenberg M, Pulsipher DT, Hermann B (2009) Association of epilepsy and comorbid conditions. Future Neurol 4:663–668

    Article  PubMed Central  PubMed  Google Scholar 

  31. Statistiska centralbyrån. Befolkningsstatistik. (statistics of Sweden. Population statistics.) Available from http://www.scb.se in Swedish

  32. Sturge C, Garralda ME, Boissin M, Dore CJ, Woo P (1997) School attendance and juvenile chronic arthritis. Br J Rheumatol 36:1218–23

    Article  CAS  PubMed  Google Scholar 

  33. Suris JC, Michaud PA, Akre C, Sawyer SM (2008) Health risk behaviors in adolescents with chronic conditions. Pediatrics 122:e1113–1118

    Article  PubMed  Google Scholar 

  34. Suris JC, Parera N (2005) Sex, drugs and chronic illness: health behaviours among chronically ill youth. Eur J Public Health 15:484–488

    Article  PubMed  Google Scholar 

  35. Svetaz MV, Ireland M, Blum R (2000) Adolescents with learning disabilities: risk and protective factors associated with emotional well-being: findings from the national longitudinal study of adolescent health. J Adolesc Health 27:340–348

    Article  CAS  PubMed  Google Scholar 

  36. Valencia LS, Cromer BA (2000) Sexual activity and other high-risk behaviors in adolescents with chronic illness: a review. J Pediatr Adolesc Gynecol 13:53–64

    Article  CAS  PubMed  Google Scholar 

  37. van der Lee JH, Mokkink LB, Grootenhuis MA, Heymans HS, Offringa M (2007) Definitions and measurement of chronic health conditions in childhood: a systematic review. JAMA 297:2741–2751

    Article  PubMed  Google Scholar 

  38. Wilens TE, Martelon M, Joshi G, Bateman C, Fried R, Petty C, Biederman J (2011) Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry 50:543–553

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Eva-Maria Annerbäck, Fredrik Granström, and Ulf Larsson at the Centre for Clinical Research Sörmland, Sweden for valuable support. We also thank Carina Seidel for fruitful discussions and Steven Lucas for help with linguistic comments. Finally, we thank all students and school staff who made this study possible.

Conflicts of Interest

This study was funded by the Centre for Clinical Research Sörmland, Uppsala University. There is no conflict of interest.

Author’s contributions

CN perfomed the statistical analyses and wrote the manuscript. EF and YT supervised the analyses and the manuscript writing.

Author information

Authors and Affiliations

  1. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

    Charlotte Nylander & Ylva Tindberg

  2. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

    Charlotte Nylander & Ylva Tindberg

  3. Department of Pediatrics, Mälarsjukhuset Hospital, 631 88, Eskilstuna, Sweden

    Charlotte Nylander

  4. The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Elisabeth Fernell

Authors
  1. Charlotte Nylander
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisabeth Fernell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ylva Tindberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charlotte Nylander.

Additional information

Communicated by Jaan Toelen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nylander, C., Fernell, E. & Tindberg, Y. Chronic conditions and coexisting ADHD—a complicated combination in adolescents. Eur J Pediatr 174, 1209–1215 (2015). https://doi.org/10.1007/s00431-015-2521-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-015-2521-9

Keywords

Search

Navigation