Conference Name: Dubai International Conference on Teaching, Education & Learning, 18-19 February 2024

Conference Dates: 18-19 February 2024

Conference Venue: Flora Creek, Deira, Dubai, UAE
Appears in: PUPIL: International Journal of Teaching, Education and Learning (ISSN 2457-0648)
Publication year: 2024

Unnati Ekbote, 2024

Volume 2024, pp. 39-53

DOI- https://doi.org/10.20319/ictel.2024.3953
This paper can be cited as: Ekbote, U. (2024). Impact of ADHD on Adolescence Behavior and other
Comorbidities focused on Conduct Disorders, ODD/CD and Anxiety Disorder. Dubai International Conference
on Teaching, Education & Learning, 18-19 February 2024. Proceedings of Teaching and Education Research
Association (TERA), 2024, 39-53.

IMPACT OF ADHD ON ADOLESCENCE BEHAVIOR AND OTHER

COMORBIDITIES FOCUSED ON CONDUCT DISORDERS,
ODD/CD AND ANXIETY DISORDER
Unnati Ekbote
Faculty of Clinical Psychology, Gyanvihar University, Hyderabad, India
unnati.ekbote@gmail.com

1. Introduction
The purpose of this research proposal is to conduct a study of ADHD impact on adolescence behavior
and other comorbidities. ADHD is the neurological disorder which is the most common childhood
disorders and characterized by a persistent and trans-situational pattern of age-inappropriate
inattention, hyperactivity, and impulsivity. The aim of the research subject is to find out how it is
impacting adolescence behavior and develop other comorbidities such as anxiety disorder, eating
disorder, ODD/CD along with analyzing the impact, causes, relations and solutions addressing the
same.

2. Research Problem Statement

The ADHD induces the common disorders involving difficulties regulating one’s actions and
emotions, significant changes in behavior, social skills or other medical conditions. It also cultivates
the behaviors such as breaking rules, disobeying authority figures, and losing one’s temper along with
changes forced due to various parental behavior patterns. This research will solely focus on few critical

39
aspects of ADHD and aims to study the factors responsible for behavior change and other
comorbidities in adolescence and try to explore the solutions to overcome such instances.

3. Research Objectives
The primary objectives of this study are as follows:
a) To identify the main cause and factors contributing to ADHD induced behavior and other
comorbidities in adolescence.
b) To assess the impact of ADHD in adolescence and mitigate the problematic behavioral patterns
and relevant comorbidities.
c) To explore the potential solutions preventing the impact of ADHD on adolescents.

4. Literature Review
a. Poor Parenting and Effect on ADHD Adolescence and its Comorbidities
A study by Preeti Jacob et al. (2021) about Parental involvement and positive parenting were
significantly associated with fewer emotional and behavioral problems in children and adolescents
diagnosed with ADHD. This has direct implications for clinical practice. Further studies are needed to
adapt parenting strategies to the Indian context.
b. Provisioning of Treatments in Low and Middle Level Income Countries for ADHD Adolescence
Access to treatment for ADHD is overall limited and varied among individual countries.
Pharmacological treatments were generally more available than psychological interventions. Several
barriers including stigma, cost, and lack of resources were reported to impact treatment acceptance.
More research in LMICs (Low, Medium Income Countries) is needed to improve and expand mental
health services in these regions.
c. Anxiety Management in Adolescents with Comorbid ADHD
As known, that anxiety disorders are prominent among the adolescent population suffering from
ADHD, with especially high prevalence in combined type ADHD.
In this research, the researcher found that, if ADHD left untreated, anxiety can negatively affect peer
relationships, social skills, and family quality of life and can exacerbate ADHD symptoms. Also, the
Comorbid anxiety disorders do not change how a PCP (Primary Care Physician) should treat ADHD
using pharmacotherapy; rather, it is recommended that ADHD management always be maximized
before starting an additional treatment for a cooccurring anxiety disorder.
d. Analysis of Psychological and Behavioral Impact due to Lack of Social Exposure

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As studied by Prateek Kumar Panda et al., the Anxiety, depression, irritability, boredom, inattention
are predominant new-onset psychological problems in children due to lack of social exposure. Children
with pre-existing behavioral problems like autism and attention deficit hyperactivity disorder have a
high probability of worsening of their behavioral symptoms.
e. Medical Conditions and Impact of ADHD in Adolescence with Comorbidities
In this research paper it was found that, the adolescents with medical conditions have co-morbid
psychiatric morbidities and behavioral problems. If these medical conditions not treated promptly and
left unattended then the comorbidities will increase with the time.
f. Risk of Several Adverse Behaviors
Ryan s. sultan (2021) et.al. found in their studies that the Adolescents with ADHD were found to have
had an increased risk of several adverse behaviors previously reported in adults with persistent ADHD.
The results offer a broad view of behavioral risks in adolescents with ADHD. Given strong correlations
between ADHD and these adverse behaviors and evidence that many continue into adulthood,
assessments of ADHD in pediatrics primary care settings should include evaluation of these functional
domains.
g. Impact of Internet on Adolescent Having ADHD
Verma, Lavkush et al. (2022), in their studies found that the GA was significantly higher in Distuptive
Behavior Disorder and ADHD than healthy controls. Comorbid ADHD and DBD further increase the
risk of GA in adolescents. Therefore, it is important to screen children with these disorders routinely
for GA because problematic overuse (more than 4 h/day) of Internet or video game occurs at the
expense of healthy activities such as playing with peers, academic work, and interaction with family
members. It leads to worsening of behavioral problems, disruption of daily routine activities, and
conflicts.

5. Research Gaps
Research on the impact of ADHD on adolescent behavior and comorbidities has identified several
gaps. Some areas that could benefit from further study include:
 Long-Term Outcomes: More research is needed to understand the long-term effects of ADHD
on adolescents as they transition into adulthood, including educational, occupational, and social
outcomes.
 Comorbidity Patterns: Further investigation into the specific patterns of comorbid conditions
(such as anxiety disorder, oppositional deficit disorder, and conduct disorders) in adolescents
with ADHD could provide insights into effective interventions.

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  Environmental Factors: Research could delve into the influence of various environmental
factors (e.g., parenting styles, school environments) on the behavior and outcomes of
adolescents with ADHD.
 Interventions and Treatment: Evaluating the effectiveness of various treatment approaches
(medications, behavioral therapies, psychoeducation) specifically tailored to the needs of
adolescents with ADHD is an ongoing area of investigation.
 Peer Relationships and Social Functioning: Exploring the impact of ADHD on peer
relationships, social skills development, and overall social functioning during adolescence
could provide valuable insights.
 Academic Achievement: Further research could examine the effects of ADHD on academic
performance, strategies to support educational attainment, and the role of executive functioning
deficits.
Addressing these research gaps could enhance our understanding of the impact of ADHD on adolescent
behavior and comorbidities, leading to more effective interventions and support strategies.

6. Research Questions/Hypothesis
How does ADHD affect the behavior of adolescents in school settings.
a. What are the typical behavioral challenges that adolescents with ADHD face in their daily
lives?
b. What strategies or interventions can help adolescents with ADHD improve their behavior and
performance in academic settings?
c. How might the emotional and psychological aspects of ADHD impact an adolescent's self-
esteem and self-perception?
d. How do coexisting conditions, such as anxiety, ODD/CD interact with and influence the
behavior of adolescents with ADHD?
e. What are some effective treatment approaches for managing both ADHD and comorbid
conditions in adolescents?
f. How can family dynamics and parenting strategies influence the behavior and well-being of
adolescents with ADHD?
g. Do adolescents with ADHD have an increased risk of engaging in risky or dangerous behaviors,
and if so, what are the contributing factors?
h. How might the presence of ADHD impact an adolescent's ability to develop and maintain
healthy lifestyle habits, such as exercise and nutrition?

42
 i. What are the challenges and benefits of using medication as part of a comprehensive treatment
plan for adolescents with ADHD and comorbidities?
j. What role can psychoeducation and psychotherapy play in helping adolescents with ADHD
better understand and manage their behaviors?
k. How can schools and educational institutions create supportive environments for adolescents
with ADHD, considering their unique behavioral needs?

7. Existing Techniques
1. Cross-Sectional Studies:
 These studies collect data from individuals at a single point in time and can help researchers
identify associations between ADHD and comorbidities during adolescence.
2. Case-Control Studies:
 Researchers compare individuals with ADHD to a control group without ADHD to examine
differences in behavior and comorbidities.
3. Behavioral Observations:
 Observing adolescents with ADHD in naturalistic settings (e.g., home, school) can provide
detailed insights into their behaviors, interactions, and challenges.
4. Self-Report Questionnaires and Interviews:
 Adolescents with ADHD can provide self-reports of their behavior, emotions, and experiences.
Structured interviews can gather more in-depth information.
5. Parent and Teacher Reports:
 Parents and teachers can provide valuable information on ADHD symptoms, behavior, and
interactions in different contexts.
6. Cognitive Testing:
 Assessments of cognitive functions (e.g., attention, executive functions) can help researchers
understand the specific cognitive challenges faced by adolescents with ADHD.
 Efficacy and potential effects on behavior.
7. Intervention Studies:
 Researchers can design and test interventions (e.g., behavioral therapy, educational programs)
to assess their impact on ADHD-related behaviors and comorbidities.
8. Comorbidity-Specific Studies:

43
  Researchers may focus on specific comorbidities (e.g., ADHD and anxiety) to explore the
interplay between conditions and their impact on behavior.

8. Methodology:
a. Study Design:
 A longitudinal, mixed-methods approach will be employed to capture both quantitative and
qualitative data over a designated period.
 Data will be collected at multiple time points to observe developmental changes and gather
insights into the progression of ADHD-related behaviors and comorbidities.
b. Participants:
 A diverse sample of adolescents aged 13 to 18 will be recruited.
 Participants will be divided into two groups: those diagnosed with ADHD and a control group
without ADHD.
c. Data Collection:
Quantitative Phase:
a. Assess ADHD Symptoms: Use validated ADHD rating scales and diagnostic criteria to
measure ADHD symptom severity.
b. Behavioral Assessments: Conduct standardized behavioral assessments (e.g., Conners'
Rating Scales) to capture observable behaviors.
c. Comorbidity Assessment: Administer assessments (e.g., SCARED for anxiety) to identify
and measure comorbid conditions.
d. Cognitive Testing: Utilize cognitive tasks to evaluate executive functions, attention, and
impulsivity.
Qualitative Phase:
a. In-depth Interviews: Conduct semi-structured interviews with a subset of participants to gain
insights into personal experiences, challenges, and coping strategies.
b. Focus Groups: Organize focus groups to explore social interactions, peer relationships, and
the emotional impact of ADHD and comorbidities.
e. Data Analysis:
 Quantitative data will be analyzed using appropriate statistical methods, such as correlation
analyses, regression models, and ANOVA.
 Qualitative data from interviews and focus groups will undergo thematic analysis to identify
recurring patterns and themes.

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f. Integration and Synthesis:
 Quantitative and qualitative findings will be integrated to provide a comprehensive
understanding of the impact of ADHD on adolescent behavior and comorbidities.
 Triangulation of data sources will enhance the validity and reliability of the study's conclusions.
g. Ethical Considerations:
 Obtain informed consent from participants and their guardians.
 Ensure participant confidentiality and privacy throughout the study.
 Comply with ethical guidelines for working with vulnerable populations.
h. Implications and Recommendations:
 Summarize the study's findings, highlighting key relationships between ADHD, behavior, and
comorbidities.
 Provide recommendations for interventions, support, and future research to address the
identified challenges.
9. Research Significance and Outcomes:
The significance of researching the impact of ADHD on adolescent behavior and comorbidities is
multifaceted, as it contributes to a deeper understanding of the complex interactions between ADHD
and other conditions during a critical developmental period. The outcomes of such research can have
profound implications for clinical practice, public health, education, and the overall well-being of
adolescents. Here are some key areas of significance and potential outcomes:
a. Clinical Understanding and Treatment:
 Research outcomes can provide insights into how ADHD symptoms and behaviors interact
with comorbidities such as anxiety, ODD/CD and substance use disorders.
 Enhanced understanding can lead to more accurate diagnosis, personalized treatment plans,
and targeted interventions that address both ADHD and coexisting conditions.
b. Intervention and Support Strategies:
 Findings can guide the development of tailored intervention programs that address specific
behavioral challenges associated with ADHD and comorbidities.
 Improved interventions can help adolescents build coping skills, manage emotions, and
improve overall well-being.
c. Early Detection and Prevention:
 Research outcomes can inform the identification of early markers and risk factors for ADHD-
related behaviors and comorbidities, enabling early intervention and prevention efforts.
d. Education and School Policies:

45
  Insights into the impact of ADHD on academic performance and behavior can inform the
development of educational strategies, accommodations, and policies to support students with
ADHD.
e. Social and Interpersonal Relationships:
 Understanding the effects of ADHD and comorbidities on social interactions can lead to
improved peer relationships, reduced stigmatization, and enhanced social inclusion.
f. Public Health and Awareness:
 Research outcomes can contribute to public awareness campaigns and educational initiatives
that reduce stigma and promote understanding of ADHD and its impact on behavior.
g. Family Support and Dynamics:
 Findings can help families better understand and navigate the challenges associated with
ADHD and comorbidities, fostering improved communication and support.
j. Long-Term Outcomes and Quality of Life:
 Understanding the long-term effects of ADHD-related behaviors and comorbidities on
educational attainment, employment, relationships, and overall quality of life is crucial for
guiding interventions and support.
Ultimately, research on the impact of ADHD on adolescent behavior and comorbidities has the
potential to improve the lives of adolescents and their families by providing a deeper understanding of
the challenges they face and informing effective strategies for intervention, support, and advocacy.

10. Limitations
ADHD can have various impacts on adolescent behavior and may be associated with comorbidities.
Some limitations of its impact include:
 Data availability and quality: data might be incomplete, outdated, or not easily accessible which
could impact the accuracy of the findings.
 Universality: The findings of the study might be specific to the gender and age group and may
not be applicable to other group.
 Timeframe: The study’s time constraint might not allow for an in-depth analysis of long-term
trends.
 Developmental Changes: Adolescence is a period of rapid physical, emotional, and cognitive
development. This can make it challenging to differentiate between typical adolescent behavior
and ADHD-related behavior.

46
  Situational Factors: Environmental influences, family dynamics, peer interactions, and socio-
economic factors can interact with ADHD symptoms, making it difficult to isolate their sole
impact on behavior.
 Treatment and Coping Strategies: Effective interventions, including medication and behavioral
therapy, can mitigate some of the negative effects of ADHD on behavior and functioning. These
strategies can limit the observable impact of ADHD symptoms.
 Increasing Maturity Level: Some adolescents may experience a reduction in certain ADHD
symptoms as they mature, which can lessen the apparent impact on behavior.
 Self-Awareness and Coping: Adolescents with ADHD may develop self-awareness and coping
mechanisms to manage their symptoms, which could mask the full extent of their impact on
behavior.
 Social and Academic Demands: The demands of school, peer relationships, and extracurricular
activities may overshadow the impact of ADHD symptoms on behavior, making it harder to
assess their true extent.
It's important to consider these limitations when assessing the impact of ADHD on adolescent behavior
and addressing any associated comorbidities.

11. Future Work Needed

There are several important areas for future research on the impact of ADHD on adolescent behavior
and comorbidities. As our understanding of ADHD and its interactions with other conditions continues
to evolve, further research is needed to address existing gaps and advance knowledge in this field.
Here are some potential areas for future work:
a. Longitudinal Studies:
 Conduct longitudinal studies that follow adolescents with ADHD over an extended period to
track the developmental trajectories of both ADHD symptoms and associated comorbidities.
b. Neurobiological Mechanisms:
 Explore the underlying neurobiological mechanisms that contribute to the interplay between
ADHD and comorbidities, using advanced neuroimaging techniques and genetic studies.
c. Mechanisms of Comorbidity:
 Investigate the specific mechanisms that link ADHD to various comorbid conditions, such as
anxiety, conduct disorders, and substance use disorders.
d. Treatment Outcomes:

47
  Conduct rigorous trials to evaluate the efficacy of integrated treatment approaches targeting
both ADHD symptoms and comorbidities, and assess long-term treatment outcomes.
e. School and Educational Contexts:
 Explore the role of educational environments, classroom accommodations, and support
systems in shaping the behavior and academic outcomes of adolescents with ADHD and
comorbidities.
f. Peer Relationships and Social Integration:
 Investigate the impact of ADHD and comorbidities on peer relationships, social interactions,
and the development of social skills in adolescents.
g. Technology-Based Interventions:
 Research the effectiveness of digital interventions, such as mobile apps or online platforms, in
supporting adolescents with ADHD and comorbidities in managing their behavior and well-
being.
h. Family Dynamics and Support:
 Examine the role of family dynamics, parenting styles, and family support in influencing the
behavior and mental health outcomes of adolescents with ADHD and comorbidities.
i. Transition to Adulthood:
 Investigate the challenges and opportunities that adolescents with ADHD and comorbidities
face during the transition to adulthood, including educational, vocational, and psychosocial
aspects.
j. Peer and School Interventions:
 Explore the effectiveness of peer mentoring programs, school-based interventions, and
extracurricular activities in promoting positive behavior and reducing the impact of
comorbidities.

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