# The role of comorbid childhood mental health and neurodevelopmental conditions in the persistence of ADHD symptoms: systematic review and meta‐analysis

## TL;DR

This study finds that comorbid mental health conditions in children with ADHD are linked to persistent symptoms into later stages, but the effect is reduced after adjusting for confounding factors.

## Contribution

The paper provides new evidence on how comorbid mental health conditions influence ADHD persistence using a systematic review and meta-analysis.

## Key findings

- Comorbid externalizing conditions were significantly associated with ADHD persistence (d = 0.31).
- The association between comorbid internalizing conditions and ADHD persistence was not significant after adjusting for covariates.
- Neurodevelopmental disorders were not significantly linked to ADHD persistence.

## Abstract

Children diagnosed with ADHD and other comorbid mental health conditions often exhibit more severe functional impairments than those without comorbid conditions, including a tendency for their ADHD symptoms to persist into later developmental stages. We conducted a systematic review and quantitative analysis to investigate the extent to which specific childhood comorbidities (internalizing, externalizing and neurodevelopmental conditions) predict the persistence of childhood ADHD into later developmental stages.

We extracted data from 26 studies meeting the criteria for inclusion and applied multilevel random effects models to obtain pooled estimates of Cohen's d for selected predictors on ADHD persistence.

Childhood comorbid internalizing and externalizing conditions (d = 0.19 and d = 0.31, respectively), but not neurodevelopmental disorders, were significantly associated with ADHD persistence. After adjusting for covariates (sex, age and other comorbidities), this association diminished for externalizing conditions (d
adj = 0.24) and was no longer significant for internalizing conditions (d
adj = 0.06). The association between comorbid externalizing behavior problems and ADHD persistence was found only in studies that used parent‐reported data to measure childhood ADHD and externalizing conditions, but not in studies that included teacher‐reported childhood symptoms.

Childhood comorbid externalizing and, to a lesser extent, internalizing conditions were associated with the persistence of ADHD, but this association may be partially due to confounders. Childhood comorbidity of neurodevelopmental disorders does not appear to increase the likelihood of ADHD persistence.