Untangling the Web: Understanding Psychiatric Comorbidities in Children with Developmental Disabilities

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One of the most common questions I hear in my practice is:

"Why does my child carry multiple diagnoses—autism, ADHD, anxiety, OCD—when each one sounds like it should stand alone?"

It’s a fair question. Families often feel like they’re chasing labels rather than finding clarity. But the truth is that psychiatric comorbidity is not an exception in children with developmental disabilities—it’s the expectation. Research consistently shows that 70–80% of children with autism, for example, will meet criteria for at least one additional psychiatric condition, most commonly ADHD, anxiety, or OCD. Similarly, children with ADHD are several times more likely than their neurotypical peers to develop anxiety or mood disorders.

So, what explains this overlap? Let’s step back and look through a transdiagnostic lens.

Shared Roots, Different Branches
When we see conditions like ASD, ADHD, anxiety, and OCD occurring together, it’s tempting to imagine them as separate illnesses that just happen to collide. Instead, the science points toward shared genetic and neurobiological susceptibilities that manifest in different ways.

• Genetic vulnerability: Large-scale genome studies have identified overlapping risk variants that cut across traditional diagnoses. Genes regulating dopamine and serotonin pathways, for example, are implicated in both ADHD and OCD, though the phenotypic expression diverges.
• Executive function as the bottleneck: These genetic susceptibilities often alter executive abilities—attention, working memory, inhibition, and cognitive flexibility. Think of executive function as the brain’s “air traffic control system.” When this system is under strain, planes (symptoms) may start circling in chaotic ways.
• Phenotypic expression: The same underlying vulnerability can look very different in real life. One child may struggle with distractibility, poor impulse control, and develop ADHD. Another child, with similar vulnerabilities, may funnel that same inflexibility into compulsive checking and rituals, meeting criteria for OCD. A third may show a profile of rigidity and sensory sensitivity and be diagnosed with autism.

In other words: the seed is shared, but the soil determines the bloom.

Why Diagnostic Clarity Still Matters
Families often ask me, “If everything overlaps, does the exact diagnosis even matter?”
The answer is yes—not because labels define your child, but because treatment depends on understanding the root cause of behavior.

• A child avoiding social activities because of autistic sensory overload needs different support than one avoiding due to performance anxiety.
• ADHD-related inattention requires different strategies than OCD-driven intrusive thoughts.
• Even within anxiety, treatment targets differ depending on whether avoidance is driven by separation fears, phobias, or compulsive rituals.

This is where a comprehensive neuropsychological evaluation becomes so valuable. It lets us trace the “symptom surface” back to the cognitive and emotional systems underneath, providing a roadmap that goes beyond guesswork.

Treatment Across the Spectrum
Behavioral & Psychotherapeutic Interventions

• Cognitive Behavioral Therapy (CBT) remains the gold standard for anxiety and OCD. In developmental disability populations, we adapt it—using visuals, repetition, and caregiver involvement.
• Behavioral activation and executive scaffolding are central for ADHD, helping children build structure, sustain effort, and tolerate frustration.
• Parent coaching and family therapy amplify these gains by aligning home responses and creating consistency across environments.
• For ASD, structured social skills groups, sensory regulation strategies, and flexibility training are often most effective.

While these therapies overlap in technique, the order, dosage, and emphasis differ depending on diagnostic clarity.

Pharmacotherapy
Medication plays an important role, but here again the overlap can complicate decisions.

• Stimulants (like methylphenidate) remain the frontline for ADHD but can exacerbate anxiety in susceptible children.
• SSRIs are highly effective for OCD and generalized anxiety but may increase impulsivity or activation in ADHD profiles.
• Atypical antipsychotics are sometimes prescribed for irritability in ASD, though their use requires careful weighing of metabolic side effects.

This is why “what works for one child may not work for another” is more than a cliché—it’s a reflection of how shared vulnerabilities diverge into unique symptom pathways.

Moving Forward
What I want families to know is this:

1. Your child’s comorbidities are not random. They reflect how genetic and cognitive vulnerabilities interact with environment and development.
2. Diagnostic clarity is not about labels—it’s about treatment precision.
3. Integrated care—behavioral, educational, family-based, and medical—provides the strongest outcomes.

In my own evaluations, I’ve seen again and again how untangling these threads gives families relief. Instead of feeling like they’re fighting four different battles, they can see the shared terrain—and focus on building strategies that address root vulnerabilities while respecting their child’s uniqueness.

If you’re a parent navigating this maze and wondering whether a neuropsychological evaluation might help, I invite you to reach out. Together, we can bring order to complexity and chart a path forward grounded in both science and compassion.

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By Micah Savin, Ph.D.
Dr. Savin is an Ivy League-trained clinical neuropsychologist with expertise in behavioral interventions that optimize equity in development, aging, and health.