If your child has experienced any concerning changes recently—a major drop in grades, rocky friendships, problems sleeping or eating—it may be time to get a professional mental health evaluation. If your child receives a diagnosis, you may feel more at ease. That’s because you can then take the appropriate next steps toward getting help.
But what if that diagnosis is accompanied by a second mental health or behavioral diagnosis? What if, for example, your child has both attention deficit hyperactivity disorder (ADHD) and a behavior disorder, or both depression and anxiety?
Mental health comorbidities (when a person has more than one condition at the same time) are surprisingly common in kids and teens. About 52 percent of children and teens with ADHD also have a behavior or conduct problem, and 33 percent have ADHD and anxiety, according to the Centers for Disease Control and Prevention. About 70 percent of children and youth with obsessive-compulsive disorder (OCD) face other mental health conditions too. Comorbid anxiety and OCD in children is one of the most common examples.
Among kids and teens with depression, 74 percent also have anxiety. It’s also possible to have three conditions at the same time, such as anxiety, depression, and a behavior disorder.
That’s a lot for any parent to face. So, how do you help your child manage multiple comorbidities? Seek help early, and work with a clinician on a treatment plan that is tailored for your child. Use these steps as a guide.
Step #1: Start with the Right Diagnosis
The possibility that your child may have more than one mental health condition emphasizes just how important it is to get a diagnosis you trust, says Mark A. Novitsky Jr., MD, a child and adolescent psychiatrist at Potomac Psychiatry in Rockville, Maryland.
“Most parents come to a child psychiatrist because they have been through trial and error in diagnosis and are frustrated,” he says. “There’s no substitute for a comprehensive evaluation by a skilled clinician.”
Your child’s clinician will gather a wide array of information during the diagnostic process, including:
- Psychiatric and medical history
- Academic or school history
- Family dynamics and history
- Sleep, exercise, and eating habits
Come to the appointment prepared with notes about any behavior issues you’ve noticed, says Amy Edgar, APRN, a nurse practitioner and founder of the Children’s Integrated Center for Success in Allentown, Pennsylvania. Be ready to talk about how any of these issues are impacting the daily life of your child or family.
Help your child participate in the discussion where appropriate. For example, encourage older children and teens to answer questions directed at them.
Step #2: Consider Pharmacogenetic (PGx) Testing
Once a diagnosis is made, treatment can begin. Often, that includes mental health medication.
To help them personalize a treatment plan for a child or teen, Dr. Novitsky and Edgar both conduct pharmacogenetic (PGx) testing with Genomind. It’s a way to help them understand how a patient’s unique genetic makeup may affect how their body might respond to mental health medications as well as many other types of prescription drugs.
“It’s like having a roadmap to help with making treatment decisions,” Dr. Novitsky says. When a child or teen has been diagnosed with more than one mental health condition, understanding their genetic makeup is especially important, he adds.
The Genomind Pharmacogenetic(PGx) Test looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications may be more or less likely to be effective
- Which medications may have side effects
- How you metabolize medications for personalized dosing guidance
Step #3: Work with Your Child’s Clinician on a Medication Plan
After a clinician receives a patient’s Genomind PGx report, they can use it to make more informed treatment decisions. “As important as finding the ‘right’ medication is avoiding going down the wrong path with a medication that could worsen a related condition,” Dr. Novitsky says.
For example, some medications for ADHD can make underlying anxiety worse, Dr. Novitsky explains. For a child with both anxiety and ADHD, he would typically treat the anxiety first before slowly introducing ADHD medications.
In some cases, Edgar has seen ADHD improve after anxiety was addressed. In other cases, she’s seen anxiety ease after treating ADHD first. What’s best for your child will require a discussion with the clinician about any possible medications.
Another example is a child with ADHD who takes a stimulant (such as Ritalin, Concerta, Adderall, or Vyvanse) but becomes irritable when each daily dose wears off. The traditional approach would be to use a selective serotonin reuptake inhibitor (SSRI) as an add-on to treat symptoms, Dr. Novitsky explains. SSRIs increase levels of serotonin, a chemical that helps regulate mood and behavior.
But there are some instances where SSRIs may not be a good fit for a child. If your child has a variation in the SLC6A4 gene, for example, their body may be less equipped at transporting serotonin.
“In this case, adding an SSRI may actually make things worse,” Dr. Novitsky says. “It may result in unwanted side effects without much benefit. Knowing that allows me to provide a family with more tailored medication treatment options.”
During the treatment process, don’t be afraid to ask questions about medications for your child. In fact, it’s a great idea to ask what a medication is and why a clinician does—or does not—recommend it. A good clinician will welcome questions and partnering with you.
“Offering the opportunities to have a scientifically based, child-centered approach to choosing medication in these situations offers a great deal of comfort to families,” Dr. Novitsky says.
Step #4: Discuss Quality of Life and What Matters to You
In addition to a child’s diagnosis and Genomind PGx report, Edgar says she also pays close attention to how the child and family describe day-to-day living.
“In the case of a child who has more than one condition, like ADHD and anxiety, we need to manage both conditions,” she explains. “But ultimately we need to pick the high-value target to focus on first and then come back around to the other conditions.”
In her conversations with parents and kids, she wants to listen and understand their needs as much as she wants to share any information. “I’ll say to the child, ‘What’s the thing that really bothers you?’ And then I’ll ask the parents, ‘OK, family, what’s the thing that really bothers you?’”
That’s how she learns, for example, that a child may want more help feeling successful in social situations, while the parents are focused on helping the child function well in school. The answers help her build a multipronged treatment plan that may include a combination of:
- Psychotherapy, or talk therapy
- Medications
- Social and emotional support
- School accommodations, if needed
“We have to work together to pull apart all of the symptoms and land on the right solution for each individual,” Edgar says. In the case of ADHD, this can look like some of the strategies we’ve outlined in our guide: How to Improve Focus in Kids
Does Your Medication Work for You?
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