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Applied Quiz: Co-occurring Conditions

A second set of questions on this chapter, weighted toward applying the ideas rather than recalling them. Each one gives you a picture and asks what else might be true.

1. A 15-year-old treated successfully for ADHD since age 9 is collapsing in tenth grade. His parents conclude the medication stopped working. What is the better first question?

  1. What else is true — before turning the one dial the family knows about
  2. Whether the dose should be raised to match his adolescent weight
  3. Whether he has begun skipping doses
  4. Whether the original diagnosis at age 9 was correct
Show Answer

The correct answer is A. Dev's case is built to teach the comorbidity habit of mind. The actual story was a reading disability that was cheap to hide in middle school and fatal to tenth-grade reading loads, plus six months of low mood filed under "teenager." Adjusting the stimulant — the only lever the family knew about — would have done nothing, because the wall wasn't attentional. The chapter's rule: when the picture worsens or treatment underperforms, ask what else is true before turning the one dial you know.

Concept Tested: Comorbidity

See: Chapter 6

2. A student is failing reading while doing well in math and science. What does this pattern suggest?

  1. The ADHD is worsening and needs more aggressive treatment
  2. Motivation is the issue, since the difficulty is subject-specific
  3. A learning disability — ADHD taxes everything roughly equally, while a learning disability craters one subject and spares others
  4. Nothing diagnostic, since subject preferences vary in all students
Show Answer

The correct answer is C. Domain-specific struggle is the tell. The chapter notes this pattern warrants the neuropsychological testing Chapter 5 called optional, because it is exactly the complicated picture testing exists for — and because school accommodations differ for each condition. It also describes the mutual camouflage: ADHD's missing homework hides a reading problem, and a reading problem masquerades as inattention, since nobody attends well to text they can't decode.

Concept Tested: Learning Disabilities

See: Chapter 6

3. A parent is trying to tell ADHD discouragement from depression in their teenager. What distinction does the chapter offer?

  1. Depression only affects sleep and appetite, while ADHD affects mood
  2. ADHD's discouragement is situational and interest-responsive — the person lights up when something novel arrives — while depression flattens even the interesting things
  3. Depression cannot be diagnosed alongside ADHD
  4. The two are indistinguishable without testing
Show Answer

The correct answer is B. That flattening — especially with hopelessness, withdrawal from previously loved activities, or sleep and appetite changes lasting weeks — is a screening conversation, not a phase. The chapter also refuses to soften one point: if thoughts of self-harm or suicide surface, that is an immediate professional matter, in the US by calling or texting 988, and it outranks every other priority in the book.

Concept Tested: Depression

See: Chapter 6

4. An adult with ADHD snores heavily and is foggy all day despite medication. What does the chapter recommend?

  1. Adjust the stimulant timing to cover the afternoon fog
  2. Add an afternoon dose, since the fog indicates wear-off
  3. Treat the fog as an unavoidable feature of adult ADHD
  4. A sleep-study referral — apnea shreds sleep quality invisibly and mimics ADHD outright, especially in adults
Show Answer

The correct answer is D. The chapter states plainly that snoring plus daytime fog is a sleep-study referral, not a stimulant adjustment. The broader rule for families: any serious ADHD care includes asking "how is sleep, actually?" and treating what turns up as a first-class intervention rather than lifestyle advice — because sleep loss degrades exactly the executive functions ADHD strains, silently worsening every symptom while wearing the ADHD's name.

Concept Tested: Sleep Disorders

See: Chapter 6

5. Parents worry that treating their son's ADHD with stimulants will set him up for substance problems later. What does the evidence say?

  1. Their fear is well founded; stimulant treatment raises later substance risk
  2. Treating ADHD does not raise substance risk — the research runs neutral-to-protective — while untreated ADHD is associated with earlier, more escalating use
  3. The question has not been studied enough to answer
  4. Risk is unaffected either way, since substance use is purely social
Show Answer

The correct answer is B. The chapter gives families two evidence points to hold: nicotine, alcohol, and cannabis use start earlier and escalate more often in untreated ADHD, and treating ADHD runs neutral-to-protective on substance risk — which surprises parents who fear stimulants as a gateway. The practical posture is to talk early and factually, treat the ADHD, and read self-medication as information: the teen who "needs" cannabis to sleep is reporting an untreated symptom.

Concept Tested: Substance Use Risk

See: Chapter 6

6. A clinician is deciding between ADHD and bipolar disorder in an energetic, impulsive, talkative adult. What structure distinguishes them?

  1. Severity — bipolar disorder always presents more intensely
  2. Age of onset alone, since bipolar disorder never begins in childhood
  3. Time — ADHD is chronic and always-on, while bipolar disorder is episodic, with distinct multi-day departures from baseline and reduced need for sleep
  4. Response to stimulants, which resolves the question definitively
Show Answer

The correct answer is C. "She's always been like this" points one way; "this is a different person than last month" points the other. The chapter highlights the sleep distinction as especially useful — genuinely not needing sleep, rather than having trouble sleeping. It also notes both can be true in one person, which is psychiatrist territory rather than a primary-care-visit question.

Concept Tested: Bipolar Disorder Distinction

See: Chapter 6

7. A child with ADHD is defiant at home. His parents respond with escalating punishments, and things get worse. What does the chapter say?

  1. Escalating punishment contests reliably make it worse, and much apparent opposition is transition tax, demand overload, and soured interactions
  2. The escalation is correct but has not yet been applied consistently enough
  3. The defiance confirms ODD, which requires a different discipline system
  4. Defiance at home but not school rules out any clinical explanation
Show Answer

The correct answer is A. The chapter says a meaningful share of what reads as opposition in children with ADHD is Chapter 3's transition tax plus demand overload plus years of corrective interactions souring the relationship — behavior that improves dramatically when the ADHD is treated and the demand structure repaired. True ODD is the pattern that persists across settings and relationships even after that repair, which is why option C jumps too early. The finding on escalating punishment is described as as solid as anything in the book.

Concept Tested: Oppositional Defiant Disorder

See: Chapter 6

8. A woman who spent years white-knuckling through a demanding job collapses into profound exhaustion and plummeting function. Her family wonders whether she has become lazy. What is happening?

  1. She has developed a primary depressive disorder unrelated to ADHD
  2. A motivation problem that will resolve with a short break
  3. Ordinary overwork, which rest alone will fix
  4. ADHD burnout — system collapse after an unsustainable compensation run, where the remedy starts with reducing load rather than pushing through
Show Answer

The correct answer is D. Burnout looks like depression from the outside and can become it, but its signature is collapse after over-extension. The chapter is blunt with families: a burned-out person hasn't become lazy — Chapter 1 retired that word — they've hit the wall the mask was hiding. And pushing through is the disease, not the cure. Chapter 4's Sana is the portrait. Chapter 15's caregiver sections apply too, because supporters burn out as well.

Concept Tested: ADHD Burnout

See: Chapter 6

9. A person has ADHD, moderate anxiety, and a disrupted sleep phase. A family member wants to know which gets treated first. What logic do clinicians use?

  1. Always treat ADHD first, since it is the underlying condition
  2. Safety first, then the biggest driver, with entangled pairs like sleep and ADHD worked in parallel rather than in sequence
  3. Treat conditions strictly in the order they were diagnosed
  4. Treat the least severe condition first to build momentum
Show Answer

The correct answer is B. Safety outranks everything — active suicidality, an eating disorder at medical severity, or serious substance dependence. Then the biggest driver: often the ADHD itself when anxiety and low mood are running on executive chaos, but depression first when it is severe enough to flatten engagement with any treatment. The chapter adds that there is no universal order, only a reasoned one per person — and that you are entitled to hear the reasoning.

Concept Tested: Treatment Order Decisions

See: Chapter 6

10. A child with ADHD has a history of significant adversity and shows hypervigilance and concentration problems. How should this be handled?

  1. Attribute the symptoms to trauma and defer any ADHD treatment
  2. Attribute them to ADHD, since the surface presentation matches
  3. Both may be true, and the trauma needs its own treatment lane — no stimulant treats hypervigilance
  4. Wait for the trauma symptoms to resolve before evaluating anything else
Show Answer

The correct answer is C. The differential runs on Chapter 5's tools — onset and timeline, and the texture of the inattention (ADHD's interest-steered drift versus trauma's threat-scanning). But the chapter stresses that both can be true: children with ADHD are at elevated risk of accumulating adverse experiences, and each condition worsens the other's load. The closing line is the operative one — no stimulant treats hypervigilance, so the trauma requires its own lane rather than deferral.

Concept Tested: Trauma And ADHD

See: Chapter 6