0021-7557/$ - see front matter © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
J Pediatr (Rio J). 2013;89(2):124−130
☆Please, cite this article as: Reinhardt MC, Reinhardt CA. Attention deficit-hyperactivity disorder, comorbidities, and risk situations.
J Pediatr (Rio J). 2013;89:124−30.
* Corresponding author.
E-mail: email@example.com (M.C. Reinhart).
Attention deficit-hyperactivity disorder, comorbidities,
and risk situations☆
Marcelo C. Reinhardta,*, Caciane A.U. Reinhardtb
aMSc in Psychiatry. Child and Adolescent Psychiatrist Specialist, Universidade Federal do Rio Grande do Sul,
Porto Alegre, RS, Brazil. General Psychiatrist and Physician, Universidade Federal de Pelotas, Pelotas, RS, Brazil
bCognitive-Behavior Therapy Specialist, Instituto Catarinense de Terapia Cognitiva, Florianópolis, SC, Brazil.
Psychologist, Universidade do Vale do Itajaí, Itajaí, SC, Brazil
Received 19 September 2012; accepted 31 October 2012
Objective: Attention deficit/hyperactivity disorder (ADHD) is highly prevalent, and its
symptoms often represent a significant public health problem; thus, the aim of this study
was to verify emergency situations caused by certain comorbidities, or by exposing the
patient to a higher risk of accidents.
Data source: A literature search was carried out in the PubMed database between the
years 1992 and 2012, using the key words “adhd”, “urgency”, “comorbidity”, “substance
disorder”, “alcohol”, “eating disorder”, “suicide”, “trauma”, “abuse”, “crime”,
“internet”, “videogame”, “bullying”, and their combinations. The selection considered
the most relevant articles according to the scope of the proposed topic, performed in a
Data synthesis: Several situations were observed in which ADHD is the most relevant
psychiatric diagnosis in relation to its urgency, such as the risk of accidents, suicide
risk and addition, exposure to violence, or risk of internet abuse or sexual abuse; or
when ADHD is the most prevalent comorbidity and is also correlated with emergency
situations, such as in bipolar and eating disorders.
Conclusions: The results show several comorbidities and risk situations involving the
diagnosis of ADHD, thus reinforcing the importance of their identification for the
adequate treatment of this disorder.
© 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.
All rights reserved.
ADHD, comorbidities, and risk situations 125
déficit de atenção/
Transtorno de déficit de atenção/hiperatividade, comorbidades e situações de risco
Objetivo: O transtorno de déficit de atenção/hiperatividade (TDAH) apresenta alta
prevalência, e seus sintomas apresentam-se frequentemente como um problema de
saúde pública considerável. Assim, o objetivo desta revisão é verificar estas situações
de urgência provocadas por determinadas comorbidades, ou por expor o paciente a um
maior risco de acidentes.
Fonte dos dados: Foi realizada uma pesquisa bibliográfica na base de dados PubMed
entre os anos de 1992 e 2012, utilizando os descritores “adhd”, “urgency”, “comorbidi-
ty”, “substance disorder”, “alcohol”, “eating disorder”, “suicide”, “trauma”, “abuse”,
“crime”, “internet”, “videogame”, “bullying”, e suas combinações. A seleção dos arti-
gos considerou aqueles mais relevantes de acordo com a abrangência do tema proposto,
de forma não sistemática.
Síntese dos dados: Foram encontradas diversas situações em que o TDAH é o diagnóstico
psiquiátrico mais relevante em relação à urgência, como risco de acidentes, risco de
suicídio e adição, exposição à violência ou risco de abuso de internet ou abuso sexual;
ou então o TDAH é a comorbidade mais prevalente e está igualmente correlacionada à
urgência, como no transtorno de humor bipolar e nos transtornos alimentares.
Conclusões: Nossos resultados mostram diversas comorbidades e situações de risco envol-
vendo o diagnóstico de TDAH e, assim, reforçam a importância de serem reconhecidas
para um tratamento adequado deste transtorno.
© 2013 Sociedade Brasileira de Pediatria. Publicado por Elsevier Editora Ltda.
Todos os direitos reservados.
Attention deficit/hyperactivity disorder (ADHD) is
characterized by symptoms of inattention, hyperactivity,
and impulsivity, according to the Diagnostic and Statistical
Manual of Mental Disorders - 4th Edition (DSM-IV).1 The
criteria are similar to those used by the World Health
Organization (WHO),2 but the nomenclature used in the
latter is hyperkinetic disorder. It is a psychiatric disorder of
major public health importance, considering the problems
it causes during either childhood or adolescence, at school;
during adulthood, at work; or both, regarding relationships
However, a patient with symptoms of ADHD will hardly
ever be evaluated in the emergency room, even in
emergency situations, will not be evaluated specifically
because of the symptoms. It is very likely that a patient
with ADHD will be evaluated due to the damage caused
by these symptoms. Thus, a patient will not be evaluated
due to inattention, but because of an accident that was
caused by this symptom. The patient won’t be evaluated
due to impulsivity, but will have a history of abuse of the
Internet and video games, for instance. Thus, it is necessary
to assess whether and how a person with ADHD can be
considered as being in an emergency situation, defined as
the occurrence of an unexpected health problem, whether
or not potentially life-threatening, in which the patient
requires immediate medical attention, according to the
Federal Council of Medicine.6
Obviously, a disorder as important as ADHD cannot be
summarized to one or two symptoms. The diagnosis of ADHD
is dimensional, which means that symptoms of inattention
and/or hyperactivity and impulsivity can occur in anyone,
but after a certain number of symptoms and associated
harm, the individual will be classified as having the disorder.
Thus, not every person who suffers an accident due to lack of
attention will be classified as having ADHD. It is important,
however, in a situation of risk – having suffered an accident
– to assess the situation, and to evaluate why the individual
was careless to the point of putting himself/herself at risk,
as well the frequency of such events, the damage, and the
occurrence of other ADHD symptoms, taking into account
the differential diagnosis and comorbidities.
In the case of ADHD, patients who engage in risky
behaviors are often treated initially by a pediatrician
or physician that treats adults in primary care or in the
emergency/urgency department; a careful and objective
evaluation can result in adequate referral and provide
important assistance for the patient. According to
Culpepper,7 the primary care physician should be able to
confirm a diagnosis of ADHD, identify comorbidities and
other initial problems, and provide the initial care to
this patient, taking into account family influences. The
importance of primary care is also demonstrated by Faber
et al.8 in their study, in which the use of stimulants to
treat ADHD in children and adolescents (up to age 16) was
primarily initiated by child psychiatrists in 51% of cases;
however, in 32% of the cases, treatment was initiated by
126 Reinhardt MC & Reinhardt CA
pediatricians, and in 61% of cases the prescriptions were
repeated by general practitioners.
An article from the American Academy of Pediatrics and
the American College of Emergency Physicians9 considered,
among other health problems, early diagnosis of patients
with ADHD as of vital importance in emergency services,
emphasizing how patients with ADHD may be at risk.
Furthermore, the use of health services by individuals with
ADHD throughout life has a major economic impact,10 as it is
one of the disorders most often observed in primary care.11
Another important factor is the high rate of comorbidities
in ADHD, with the onset of psychiatric disorders as early
as childhood, such as bipolar disorder, major depressive
disorder, oppositional defiant disorder, conduct disorder, and
substance abuse disorder.12 The presence of comorbidities
also occurs in adulthood.13
A recent meta-analysis study,14 encompassing 102 studies
with a total of 171,756 subjects up to 18 years in all regions
of the world, found a prevalence of ADHD of 5.29%. The
findings of this study suggest that the geographical location
has a limited role in the variability of prevalence data from
the included studies, and that can best be explained by
the heterogeneity of the methodology applied in different
studies. It is expected that up to 60% of individuals with
ADHD persist with this disorder into adulthood.15 In Rio
Grande do Sul, Rohde et al.16 found a prevalence of 5.8% of
ADHD in a sample of adolescent students. In Pelotas, a city
in Rio Grande do Sul, Anselmi et al.17 followed a sample of
4,423 children for 11 years (from birth, of a total of 5,249)
and the prevalence of attention problems and hyperactivity
was 19.9%. The ratio between boys and girls with ADHD is to
4:1,18 and the proportion found in adults is of 1:1.19
A literature search was performed in the PubMed database
between 1992 and 2012, using the keywords “adhd”,
“alcohol”, “eating disorder”, “suicide”, “trauma”,
“abuse”, “crime”, “urgency”, “internet”, “videogame”,
“bullying”, “comorbidity”, “substance disorder”, and their
combinations. Article selection considered those most
relevant, according to the scope of the proposed topic, in
a non-systematic way. A total of 35 articles were selected.
Diagnostic evaluation in attention
ADHD diagnosis is strictly clinical, based on well-defined
clinical criteria of classifications such as DSM-IV1 and
the International Classification of Diseases - 10th Edition
Findings from several studies are quite consistent,
suggesting a two-dimensional construct for the symptoms
of ADHD in unreported samples.20,21 Thus, there is evidence
supporting the DSM-IV proposal of three types of ADHD:
combined, predominantly inattentive, and predominantly
hyperactive/impulsive.1 Moreover, there are several
studies suggesting different neuropsychological profiles,
neurobiological substrate, patterns of comorbidity,
gender distribution, and harm, according to these types
At least six of nine symptoms of inattention and/or
hyperactivity/impulsivity need to be frequently present in
the last six months for the diagnosis, thus satisfying the
A criterion. The most common of the subtypes in clinical
settings is the combined, representing approximately 50%
to 75% of individuals with ADHD that are treated, while the
inattentive subtype accounts for 20% to 30%, followed by
the hyperactive-impulsive subtype, with less than 15%.26-28
While the ICD-102 mentions a list of symptoms very similar to
that of DSM-IV, it recommends a different way to establish
diagnosis, demonstrating lack of agreement between the
available classifications. Thus, ICD-10 requires a minimum
number of symptoms in the three abovementioned
There are also other differences regarding the diagnosis
by DSM-IV or by ICD-10. Sørensen et al.29 found that the
diagnosis of ADHD according to DSM-IV occurs more often
than according to ICD-10, confirming that the differences
between diagnostic classifications may be a problem in this
disorder and that they deserve attention, as well as issues
related to the diagnostic criteria in particular, which have
been discussed in detail in several studies.
Attention deficit-hyperactivity disorder
and risk of accidents
The evaluation of patients with ADHD symptoms in
emergency situations initially requires the verification
of cases treated in emergency departments and medical
emergency situations. Thus, a recent study30 evaluated
children and adolescents aged 3 to 17 years who were
treated in an emergency department, and found that
children who repeatedly suffered trauma-related visits
in this type of service had a predisposition to ADHD and
could benefit from screening for this disorder in emergency
care. Another study31 showed that the use of long-acting
psychostimulants could decrease the number of visits to
the emergency department and the costs of such services
for patients with ADHD. Compared with their siblings, ADHD
patients have a 2.11-fold greater risk of having accidental
injuries (p > 0.05).32
Two literature reviews have shown an increased risk
of driving infractions and the benefits of the use of
stimulants in the treatment of individuals with ADHD.33,34
An American study evaluated 355 adolescents and young
adults in relation to dangerous driving - fines and accidents
– and found that ADHD in childhood increases the risk for
problems related to driving, especially those related to
the maintenance of hyperactivity/impulsivity symptoms,
and comorbidity with conduct disorder. Another study
followed specifically hyperactive children into adulthood,
and found more problems and fines related to driving when
ADHD, comorbidities, and risk situations 127
compared to controls.35 Thus, there is an evident need
for better psychiatric evaluation of patients involved in
accidents, not only for ADHD, but also for other disorders
(which may be comorbidities) equally related to accidents,
such as major depressive disorder and alcohol dependence
A recent study in Turkey37 with 475 children aged between
8 and 17 years found a significant association between
dental trauma and ADHD (p = 0.0001). A review38 on the
subject showed that traumas in playground accidents, as
well as falls and collisions during games and sports, are
the most common causes of dental trauma in childhood;
the study indicated the same strong association with ADHD.
Another American study with 161 children39 demonstrated
an association between symptoms of hyperactivity and
impulsivity with dental trauma (p < 0.001).
Attention deficit-hyperactivity disorder, suicide,
and addiction risk
Daviss & Diler40 also found an association between ADHD
and suicide, in a group of adolescents aged 11 to 18 years,
but their findings call for special attention to conflicts
between parents and the child, trauma victimization,
social impairment, and depression, more than for levels of
Two recent studies41,42 found an association between
ADHD and suicide, and one of these studies found
an association especially in young men; however, an
increased risk of suicide was observed in patients with
comorbidities, particularly those with conduct disorder
and depression. Another study43 in patients with substance
use disorders (SUDs) found that the presence of ADHD
increases the risk of attempted suicide in men. The
presence of comorbidities should also be investigated in
patients with ADHD, and once a psychiatric disorder is
detected, it becomes important to assess the presence
of ADHD. A patient with SUDs that comes for evaluation
should have his/her history assessed for the presence of
ADHD, as studies have shown a high prevalence of ADHD
in adult patients with SUDs.44,45 A longitudinal study46
found that the presence of conduct disorder in childhood
increased the risk for SUDs, bipolar disorder, and smoking
as adolescents or young adults. Another study,47 carried out
in Rio Grande do Sul, found that adolescents with ADHD
are at increased risk for SUDs, even after adjustment for
confounding factors (conduct disorder, ethnicity, religion,
and estimated IQ).
Attention deficit-hyperactivity disorder
and comorbidity with bipolar disorder
One problem of diagnosis, as well as of treatment, is the
comorbid presence of ADHD with bipolar disorder. Singh
et al.48 found a high prevalence of ADHD in patients with
bipolar disorder - up to 85%, while the rate of bipolar
disorder in patients with ADHD reached 22%. Donfrencesco
et al.49 analyzed children with comorbidity between ADHD
and bipolar disorder, and concluded that the identification
of clinical characteristics with an increased risk for bipolar
disorder could favor diagnosis, prognosis, and treatment.
Wingo & Ghaemi50 found a rate of 40% association of mania
and hypomania caused by stimulant use, and found that
25% of the bipolar patients studied had previously received
Attention deficit-hyperactivity disorder
Bullying has also shown to be related with ADHD in a study
with 10-year-old children,51 both as perpetrators and
victims. Another study52 found that autistic children with
ADHD are at increased risk for bullying at school.
The association between ADHD and criminal behavior
was assessed by Vreugdenhil et al.,53 who found that 8%
of young offenders were diagnosed with ADHD, while a
study of adolescent offenders found that 10.6% of subjects
had this diagnosis, using the DSM-IV criteria in a clinical
interview.54 Satterfield et al.55 found an increased risk of
criminal behavior in adulthood in boys with hyperactive
subtype ADHD and conduct disorder comorbidity.
Attention deficit-hyperactivity disorder
and Internet and video games addiction
Internet addiction and its comorbidity with ADHD was
assessed by Ha et al.56 and by Yen et al.57 Among the
numerous comorbidities, it appears that ADHD is the
most prevalent in children and adolescents, probably due
to impulsivity.58 Chan & Rabinowitz59 found a significant
association between playing video games for more than 1
hour a day and inattention (p < 0.001) and ADHD (p = 0.018
and 0.020) at the Conners’ Parent Rating Scale (CPRS). Yoo
et al.60 found significant associations between levels of
ADHD symptoms and severity of Internet addiction, showing
that 22.5% of the students diagnosed in the study with
Internet addiction had ADHD (vs. 8.1% of non-addicts).
Attention deficit-hyperactivity disorder
and sexual abuse
The risk of sexual abuse was also evaluated; Çengel-Kultur
et al.61 found that 22.2% of children and adolescents
who were victims of abuse had been diagnosed with
ADHD (it was the most common diagnosis). Briscoe-
Smith and Hinshaw62 found high rates of abuse in girls
with ADHD (14.3%) compared with the control sample
(4.5%). Another study63 showed that emotional abuse
and neglect are more common among men and women
with ADHD (compared to controls), as well as that sexual
abuse and physical neglect are more commonly reported
by women with ADHD. This study showed a significant
correlation between childhood abuse, depression, and
anxiety in adulthood, although an ADHD diagnosis was
a better predictor of worse psychosocial functioning in
adulthood. Sugaya et al.64 evaluated adults and found
that physical abuse in childhood (8% of respondents) was
associated with a significant increase in the adjusted
odds ratio (AOR = 1.16 to 2.28) for mental disorders,
especially ADHD, post-traumatic stress disorder, and
128 Reinhardt MC & Reinhardt CA
Attention deficit-hyperactivity disorder
and eating disorders
In relation to eating disorders, Mattos et al.65 studied a
sample of Brazilian girls, finding a high number of patients
with ADHD and eating disorders, especially binge-eating
disorder. Biederman et al.66 found that girls with ADHD have
a 3.6-fold higher risk of having criteria for an eating disorder
than controls. In addition, girls with eating disorders had
higher rates of major depression, anxiety disorders, and
disruptive behavior disorders than girls with ADHD without
The findings of this review reinforce the need for
identification of ADHD symptoms and the recognition of
this disorder as possibly associated with risk factors that
are relevant in clinical practice. Leslie et al.67 showed
the importance of protocols for an improved treatment of
ADHD patients in accordance with better understanding
of the disorder, and Abikoff et al.68 found that emergency
situations need fast and direct interventions, and that
a manual as the one proposed by the study “Multimodal
Treatment of Children with ADHD-MTA” – ASAP manual –
could be applied in these situations.
Another study, by Thapar & Thapar,69 verified that many
doctors working in primary care lacked confidence to
manage ADHD, and that most of them had received little
or no training in child psychiatry.
A review70 showed that pediatricians are in a privileged
position for early detection of ADHD in children and
adolescents, and even for the initial management of some
less severe cases. Professional training of primary health
care providers for an accurate diagnosis of ADHD or for
referral of a patient with possible ADHD symptoms is
Lopez Seco et al.71 sought to identify, in a clinical
sample, factors associated with worse prognosis in
patients with ADHD, and found a greater association
with comorbidities, a higher percentage of patients
without medication, and presence of other risk factors,
such as inadequacy of parental structure, adverse social
and family environments, and psychosocial stress. The
present findings corroborate the findings of that study,
showing that ADHD may be associated with risk situations,
and reinforce the need to identify factors associated
with these risks, whether they are comorbidities more
commonly associated with ADHD and risks or other
factors associated with poor prognosis, for appropriate
treatment of these situations.
This review showed various risk situations and comorbidities
that are more often associated with ADHD regarding
emergencies, and reinforces the importance of their
identification for a more adequate treatment of this
Conflicts of interest
Marcelo C. Reinhardt received financial support when
traveling to attend conferences and symposia from Shire,
Janssen, and Novartis; he has also been a lecturer for
Janssen and Novartis (considering the last five years).
1. American Psychiatry Association (APA). Diagnostic and
Statistical Manual of Mental Diseases. 4th ed. Washington, DC:
American Psychiatric Association; 1994.
2. World Health Organization (WHO). The ICD-10 Classification of
Mental and Behavior Disorders. Geneva: WHO; 1992.
3. Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide
prevalence of ADHD: is it an American condition? World
4. Barkley RA, Anastopoulos AD, Guevremont DC, Fletcher KE.
Adolescents with ADHD: patterns of behavioral adjustment,
academic functioning, and treatment utilization. J Am Acad
Child Adolesc Psychiatry. 1991;30:752-61.
5. Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ.
Long-term school outcomes for children with attention-deficit/
hyperactivity disorder: a population-based perspective. J Dev
Behav Pediatr. 2007;28:265-73.
6. Conselho Federal de Medicina. Resolução n.º 1451/95, artigo
1º, parágrafo 1º. Publicada no D.O.U. de 17/03/1995, Seção I,
7. Culpepper L. Primary care treatment of attention-deficit/
hyperactivity disorder. J Clin Psychiatry. 2006;67:51-8.
8. Faber A, Kalverdijk LJ, de Jong-van den Berg LT, Hugtenburg
JG, Minderaa RB, Tobi H. Parents report on stimulant-treated
children in the Netherlands: initiation of treatment and follow-
up care. J Child Adolesc Psychopharmacol. 2006;16:432-40.
9. American Academy of Pediatrics; American College of
Emergency Physicians, Dolan MA, Mace SE. Pediatric mental
health emergencies in the emergency medical services system.
American College of Emergency Physicians. Ann Emerg Med.
10. Pelham WE, Foster EM, Robb JA. The economic impact of
attention-deficit/hyperactivity disorder in children and
adolescents. J Pediatr Psychol. 2007;32:711-27.
11. American Academy of Pediatrics. Subcommittee on Attention-
Deficit/Hyperactivity Disorder and Committee on Quality
Improvement. Clinical practice guideline: treatment of the
school-aged child with attention-deficit/hyperactivity disorder.
12. Biederman J, Newcorn J, Sprich S. Comorbidity of attention
deficit hyperactivity disorder with conduct, depressive,
anxiety, and other disorders. Am J Psychiatry. 1991;148:
13. Miller TW, Nigg JT, Faraone SV. Axis I and II comorbidity in
adults with ADHD. J Abnorm Psychol. 2007;116:519-28.
14. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA.
The worldwide prevalence of ADHD: a systematic review and
metaregression analysis. Am J Psychiatry. 2007;164:942-8.
15. Wilens TE, Faraone SV, Biederman J. Attention-deficit/
hyperactivity disorder in adults. JAMA. 2004;292:619-23.
16. Rohde LA, Biederman J, Busnello EA, Zimmermann H, Schmitz
M, Martins S, et al. ADHD in a school sample of Brazilian
adolescents: a study of prevalence, comorbid conditions, and
impairments. J Am Acad Child Adolesc Psychiatry. 1999;38:
17. Anselmi L, Menezes AM, Barros FC, Hallal PC, Araújo CL,
Domingues MR, et al. Early determinants of attention and
ADHD, comorbidities, and risk situations 129
hyperactivity problems in adolescents: the 11-year follow-up
of the 1993 Pelotas (Brazil) birth cohort study. Cad Saúde
18. Cantwell DP. Attention deficit disorder: a review of the past 10
years. J Am Acad Child Adolesc Psychiatry. 1996;35:978-87.
19. Faraone SV, Biederman J, Monuteaux MC. Attention-deficit
disorder and conduct disorder in girls: evidence for a familial
subtype. Biol Psychiatry. 2000;48:21-9.
20. Lahey BB, Applegate B, McBurnett K, Biederman J, Greenhill L,
Hynd GW, et al. DSM-IV field trials for attention deficit
hyperactivity disorder in children and adolescents. Am J
21. Rohde LA, Szobot C, Polanczyk G, Schmitz M, Martins S,
Tramontina S. Attention-deficit/hyperactivity disorder in a
diverse culture: do research and clinical findings support the
notion of a cultural construct for the disorder? Biol Psychiatry.
22. Gaub M, Carlson CL. Behavioral characteristics of DSM-IV ADHD
subtypes in a school-based population. J Abnorm Child Psychol.
23. Baumgaertel A, Wolraich ML, Dietrich M. Comparison of
diagnostic criteria for attention deficit disorders in a German
elementary school sample. J Am Acad Child Adolesc Psychiatry.
24. Schmitz M, Cadore L, Paczko M, Kipper L, Chaves M, Rohde LA,
et al. Neuropsychological performance in DSM-IV ADHD
subtypes: an exploratory study with untreated adolescents.
Can J Psychiatry. 2002;47:863-9.
25. Hesslinger B, Thiel T, Tebartz van Elst L, Hennig J, Ebert D.
Attention-deficit disorder in adults with or without
hyperactivity: where is the difference? A study in humans using
short echo (1)H-magnetic resonance spectroscopy. Neurosci
26. Swanson JM, Kinsbourne M, Nigg J, Lanphear B, Stefanatos GA,
Volkow N, et al. Etiologic subtypes of attention-deficit/
hyperactivity disorder: brain imaging, molecular genetic and
environmental factors and the dopamine hypothesis.
Neuropsychol Rev. 2007;17:39-59.
27. Paternite CE, Loney J, Roberts MA. External validation of
oppositional disorder and attention deficit disorder with
hyperactivity. J Abnorm Child Psychol. 1995;23:453-71.
28. Morgan AE, Hynd GW, Riccio CA, Hall J. Validity of DSM-IV ADHD
predominantly inattentive and combined types: relationship to
previous DSM diagnoses/subtype differences. J Am Acad Child
Adolesc Psychiatry. 1996;35:325-33.
29. Sørensen MJ, Mors O, Thomsen PH. DSM-IV or ICD-10-DCR
diagnoses in child and adolescent psychiatry: does it matter?
Eur Child Adolesc Psychiatry. 2005;14:335-40.
30. Ertan C, Özcan ÖÖ, Pepele MS. Paediatric trauma patients and
attention deficit hyperactivity disorder: correlation and
significance. Emerg Med J. 2012;29:911-4.
31. Leibson CL, Barbaresi WJ, Ransom J, Colligan RC, Kemner J,
Weaver AL, et al. Emergency department use and costs for
youth with attention-deficit/hyperactivity disorder: associations
with stimulant treatment. Ambul Pediatr. 2006;6: 45-53.
32. Shilon Y, Pollak Y, Aran A, Shaked S, Gross-Tsur V. Accidental
injuries are more common in children with attention deficit
hyperactivity disorder compared with their non-affected
siblings. Child Care Health Dev. 2012;38:366-70.
33. Barkley RA, Cox D. A review of driving risks and impairments
associated with attention-deficit/hyperactivity disorder and
the effects of stimulant medication on driving performance. J
Safety Res. 2007;38:113-28.
34. Jerome L, Habinski L, Segal A. Attention-deficit/hyperactivity
disorder (ADHD) and driving risk: a review of the literature and
a methodological critique. Curr Psychiatry Rep. 2006;8:
35. Fischer M, Barkley RA, Smallish L, Fletcher K. Hyperactive
children as young adults: driving abilities, safe driving behavior,
and adverse driving outcomes. Accid Anal Prev. 2007;39:
36. Lapham SC, C’de Baca J, McMillan GP, Lapidus J. Psychiatric
disorders in a sample of repeat impaired-driving offenders.
J Stud Alcohol. 2006;67:707-13.
37. Sabuncuoglu O, Taser H, Berkem M. Relationship between
traumatic dental injuries and attention-deficit/hyperactivity
disorder in children and adolescents: proposal of an explanatory
model. Dent Traumatol. 2005;21:249-53.
38. Sabuncuoglu O. Traumatic dental injuries and attention-deficit/
hyperactivity disorder: is there a link? Dent Traumatol. 2007;
39. Thikkurissy S, McTigue DJ, Coury DL. Children presenting with
dental trauma are more hyperactive than controls as measured
by the ADHD rating scale IV. Pediatr Dent. 2012;34:28-31.
40. Daviss WB, Diler RS. Suicidal behaviors in adolescents with
ADHD: associations with depressive and other comorbidity,
parent-child conflict, trauma exposure, and impairment. J
Atten Disord. 2012 Jul 19. http://dx.doi.org/10.1177/
41. James A, Lai FH, Dahl C. Attention deficit hyperactivity disorder
and suicide: a review of possible associations. Acta Psychiatr
42. Manor I, Gutnik I, Ben-Dor DH, Apter A, Sever J, Tyano S, et al.
Possible association between attention deficit hyperactivity
disorder and attempted suicide in adolescents – a pilot study.
Eur Psychiatry. 2010;25:146-50.
43. Kelly TM, Cornelius JR, Clark DB. Psychiatric disorders and
attempted suicide among adolescents with substance use
disorders. Drug Alcohol Depend. 2004;73:87-97.
44. Carroll KM, Rounsaville BJ. History and significance of childhood
attention deficit disorder in treatment-seeking cocaine abusers.
Compr Psychiatry. 1993;34:75-82.
45. Schubiner H, Tzelepis A, Milberger S, Lockhart N, Kruger M,
Kelley BJ, et al. Prevalence of attention-deficit/hyperactivity
disorder and conduct disorder among substance abusers. J Clin
46. Biederman J, Petty CR, Dolan C, Hughes S, Mick E, Monuteaux
MC, et al. The long-term longitudinal course of oppositional
defiant disorder and conduct disorder in ADHD boys: findings
from a controlled 10-year prospective longitudinal follow-up
study. Psychol Med. 2008;38:1027-36.
47. Szobot CM, Rohde LA, Bukstein O, Molina BS, Martins C, Ruaro
P, et al. Is attention-deficit/hyperactivity disorder associated
with illicit substance use disorders in male adolescents? A
community-based case-control study. Addiction. 2007;102:
48. Singh MK, DelBello MP, Kowatch RA, Strakowski SM. Co-
occurrence of bipolar and attention-deficit hyperactivity
disorders in children. Bipolar Disord. 2006;8:710-20.
49. Donfrancesco R, Miano S, Martines F, Ferrante L, Melegari MG,
Masi G. Bipolar disorder co-morbidity in children with attention
deficit hyperactivity disorder. Psychiatry Res. 2011;186:333-7.
50. Wingo AP, Ghaemi SN. Frequency of stimulant treatment and of
stimulant-associated mania/hypomania in bipolar disorder
patients. Psychopharmacol Bull. 2008;41:37-47.
51. Holmberg K, Hjern A. Bullying and attention-deficit-
hyperactivity disorder in 10-year-olds in a Swedish community.
Dev Med Child Neurol. 2008;50:134-8.
52. Montes G, Halterman JS. Bullying among children with autism
and the influence of comorbidity with ADHD: a population-
based study. Ambul Pediatr. 2007;7:253-7.
53. Vreugdenhil C, Doreleijers TA, Vermeiren R, Wouters LF, van
den Brink W. Psychiatric disorders in a representative sample
of incarcerated boys in the Netherlands. J Am Acad Child
130 Reinhardt MC & Reinhardt CA
Adolesc Psychiatry. 2004;43:97-104.
54. Reinhardt M, Pheula G, Karam R, Zingano B, Falceto O.
Prevalência de diagnósticos psiquiátricos em adolescentes
infratores no centro de internação provisória de Porto Alegre-
RS. Paper presented at XIX Congresso da ABENEPI. 2007
55. Satterfield JH, Faller KJ, Crinella FM, Schell AM, Swanson JM,
Homer LD. A 30-year prospective follow-up study of hyperactive
boys with conduct problems: adult criminality. J Am Acad Child
Adolesc Psychiatry. 2007;46:601-10.
56. Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH. Psychiatric
comorbidity assessed in Korean children and adolescents who
screen positive for Internet addiction. J Clin Psychiatry.
57. Yen JY, Ko CH, Yen CF, Wu HY, Yang MJ. The comorbid psychiatric
symptoms of Internet addiction: attention deficit and
hyperactivity disorder (ADHD), depression, social phobia, and
hostility. J Adolesc Health. 2007;41:93-8.
58. Cao F, Su L, Liu T, Gao X. The relationship between impulsivity
and Internet addiction in a sample of Chinese adolescents. Eur
59. Chan PA, Rabinowitz T. A cross-sectional analysis of video games
and attention deficit hyperactivity disorder symptoms in
adolescents. Ann Gen Psychiatry. 2006;5:16.
60. Yoo HJ, Cho SC, Ha J, Yune SK, Kim SJ, Hwang J, et al. Attention
deficit hyperactivity symptoms and internet addiction.
Psychiatry Clin Neurosci. 2004;58:487-94.
61. Cengel-Kültür E, Cuhadaroğlu-Cetin F, Gökler B. Demographic
and clinical features of child abuse and neglect cases. Turk J
62. Briscoe-Smith AM, Hinshaw SP. Linkages between child abuse
and attention-deficit/hyperactivity disorder in girls: behavioral
and social correlates. Child Abuse Negl. 2006;30:1239-55.
63. Rucklidge JJ, Brown DL, Crawford S, Kaplan BJ. Retrospective
reports of childhood trauma in adults with ADHD. J Atten
64. Sugaya L, Hasin DS, Olfson M, Lin KH, Grant BF, Blanco C. Child
physical abuse and adult mental health: a national study. J
Trauma Stress. 2012;25:384-92.
65. Mattos P, Saboya E, Ayrão V, Segenreich D, Duchesne M,
Coutinho G. Comorbid eating disorders in a Brazilian attention-
deficit/hyperactivity disorder adult clinical sample. Rev Bras
66. Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL,
Zeitlin S. Are girls with ADHD at risk for eating disorders?
Results from a controlled, five-year prospective study. J Dev
Behav Pediatr. 2007;28:302-7.
67. Leslie LK, Weckerly J, Plemmons D, Landsverk J, Eastman S.
Implementing the American Academy of Pediatrics attention-
deficit/hyperactivity disorder diagnostic guidelines in primary
care settings. Pediatrics. 2004;114:129-40.
68. Abikoff H, Arnold LE, Newcorn JH, Elliott GR, Hechtman L,
Severe JB, et al. Emergency/Adjunct services and attrition
prevention for randomized clinical trials in children: the MTA
manual-based solution. J Am Acad Child Adolesc Psychiatry.
69. Thapar A, Thapar A. Is primary care ready to take on Attention
Deficit Hyperactivity Disorder? BMC Fam Pract. 2002;3:7.
70. Rohde LA, Halpern R. Transtorno de déficit de atenção/
hiperatividade: atualização. J Pediatr (Rio J). 2004;80:
71. López Seco F, Masana Marín A, Martí Serrano S, Acosta García S,
Gaviria Gómez AM. The course of attention deficit/hyperactivity
disorder in an outpatient sample. An Pediatr (Barc). 2012;