ADHD and Depression

New research published in the Archives of General Psychiatry shows that children with ADHD are at an increased risk for depression and suicidal thoughts -- and very well may need treatment for both. This reinforces the belief that parents and educators of even young children with ADHD should pay close attention to their child's behavior.

Twenty-year-old Ariel has been living both with anxiety and depression since the eighth grade. She says, "It got so bad where I just slept all day, I didn't get out of bed, I didn't do anything."

That is in addition to attention deficit disorder. Ariel says, "I was already upset and depressed about the fact that I had ADD and had to take medications for that. When I found out I had two more things, I was like, 'Oh my God! What's going on?'"

Research from Harvard University shows girls with attention deficit are 19 times more likely to be depressed...and 15 times more likely to have bi-polar disorder than other girls.

Dr. Richard Winer, an Atlanta-area psychiatrist, says, "There is a very high likelihood that there will be something else besides ADHD going on, probably at least a 70 percent chance if not more."

Why is one person so likely to have several disorders? Researchers say the conditions are genetically linked...and tend to aggravate each other.

Ariel says, "I try to do something, but I can't because of the ADD, and it frustrates me. Then that makes me very nervous and anxious and that goes to the anxiety. And then when I get like that, I'll go 'Oh my god! I can't do anything! I can't do anything!' And that leads to the depression."

Experts say girls like Ariel often need one medication for ADHD and another for depression.

Dr. Winer says, "I generally will try to treat ADHD first if I think there is also mild to moderate depression alongside. If the depression appears to be extremely severe in nature, then that takes precedence over treating ADHD in terms of what do you treat first."

Ariel often skips her medication. She says it's a crutch, but it does work. Her mom Arlene says, "She started taking some anti-depressants, and all of a sudden she was back to the way she had been six months earlier."

Another study out of Harvard University shows boys with ADHD are also at risk for having another mental health problem, but the statistics are slightly less dramatic than they are for girls.

Many parents seem to be ignoring medical advice when it comes to treating their child's attention deficit hyperactivity disorder (ADHD). A study conducted at New York University reveals that of 500 parents whose children have ADHD, 45 percent say behavioral therapy has been recommended, but less than one-quarter (21 percent) say that their child actually participates in it. In addition, 89 percent of parents with an ADHD child say medication has been prescribed for their child to help manage symptoms, but only 55 percent report their child is taking medication.

The study also included the following findings:

More than twice as many parents of children with ADHD (43 percent) than parents of children without ADHD (18 percent) believe their child is likely to be picked on at school.Nearly half (49 percent) of parents of ADHD children say their child is likely to have difficulty getting along with other neighborhood children (compared to 18 percent of parents of children without ADHD).Seventy-two percent of parents of ADHD children report their child has trouble getting along with siblings or other family members, compared to 53 percent of parents of children without ADHD.Less than half (48 percent) of parents of children with ADHD say their child adapts easily to new situations, compared to 84 percent of parents of children without ADHD.According to their parents, children with ADHD are half as likely to have many good friends (18 percent vs. 36 percent) and are less likely to play with a group of friends (38 percent vs. 50 percent), compared to children without ADHD.

If you believe your child may have ADHD, keep an eye out for the following symptoms listed by the American Academy of Child and Adolescent Psychiatry:

Has trouble paying attentionShows no attention to details and makes careless mistakesEasily distractedLoses school supplies and forgets to turn in homeworkHas trouble finishing class work and homeworkHas trouble listeningHas trouble following multiple adult commandsBlurts out answersDemonstrates impatienceFidgets or squirmsLeaves seat and runs about or climbs excessivelySeems "on the go"Talks too much and has difficulty playing quietlyInterrupts or intrudes on others

Depression is not limited to kids with ADHD, although having ADHD may lead to depression in some cases. According to the Mental Health America, depression among teenagers is increasing at "an alarming rate." Experts say as many as one in five teens suffers from clinical depression at some time during their teenage years. Depression can take several forms, including bipolar disorder (formerly known as manic depression). Depression can be difficult to diagnose in teens because adults often expect teens to be moody, and they often are. But depression is more than typical moodiness.

The following symptoms may indicate depression, particularly when they last for more than two weeks:

Poor performance in schoolWithdrawal from friends and activitiesSadness and hopelessnessLack of enthusiasm, energy or motivationAnger and rageOverreaction to criticismFeelings of being unable to satisfy idealsPoor self-esteem or guiltIndecision, lack of concentration or forgetfulnessRestlessness and agitationChanges in eating or sleeping patternsSubstance abuseProblems with authoritySuicidal thoughts or actions

It is extremely important that depressed teens receive prompt, professional treatment. Depression is serious and, if left untreated, can worsen to the point of becoming life threatening. If depressed teens refuse treatment, it may be necessary for family members or other concerned adults to seek professional advice. Contact your local mental health association or a school counselor for suggestions on treatment.

Some of the most common and effective ways to treat depression in adolescents are:

Cognitive-behavioral therapy ? Helps teens change negative patterns of thinking and behaving; several studies support the effectiveness of this treatmentPsychotherapy ? Provides teens an opportunity to explore events and feelings that are painful or troubling to them; psychotherapy also teaches them coping skillsInterpersonal therapy ? Focuses on how to develop healthier relationships at home and at schoolMedication ? Relieves some symptoms of depression and is often prescribed along with therapy

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Children with ADHD at increased risk for depression and suicidal thoughts as adolescents

ScienceDaily (Oct. 4, 2010) ? Children diagnosed with attention deficit/hyperactivity disorder (ADHD) at ages 4 to 6 are more likely to suffer from depression as adolescents than those who did not have ADHD at that age, according to a long-term study published in the October issue of the Archives of General Psychiatry. Although it was an uncommon occurrence, the children with ADHD also were somewhat more likely to think about or attempt suicide as adolescents.

"This study is important in demonstrating that, even during early childhood, ADHD in is seldom transient or unimportant" said study director Benjamin Lahey, Ph.D., a professor of health studies and psychiatry at the University of Chicago. "It reinforces our belief that parents of young children with ADHD should pay close attention to their child's behavior and its consequences and seek treatment to prevent possible long-term problems."

Children with ADHD have trouble paying attention and controlling impulsive behaviors and are often overly active. This can cause poor performance in school, difficulties in social situations, and a loss of confidence and self esteem. The Centers for Disease Control and Prevention estimate that about 4.4 million children, including about four percent of those aged 4 to 6, have ADHD.

Earlier studies of the long-term connections between ADHD, depression and suicidal thoughts produced mixed results. This study benefited from a more comprehensive assessment of depression over a decade, a focus on specific child and family factors that predict which children are most at risk, and consideration of other factors associated with suicidal ideas.

The study, performed by researchers at the University of Chicago and the University of Pittsburgh, followed 123 children diagnosed with ADHD at age 4 to 6 for up to 14 years, until they reached ages 18 to 20. It compared them with 119 children from similar neighborhoods and schools, matched for age, sex, and ethnicity. The children were assessed annually in study years 1 through 4, 6 through 9, and 12 through 14.

The researchers found that 18 percent of children diagnosed early with ADHD suffered from depression as adolescents, about 10 times the rate among those without ADHD. Children with early ADHD were five times as likely to have considered suicide at least once, and twice as likely to have made an attempt.

"Suicide attempts were relatively rare, even in the study group," cautioned Lahey. "Parents should keep in mind that more than 80 percent of the children with ADHD did not attempt suicide and no one in this study committed suicide."

Although the subtypes of ADHD--based on whether they had attention deficit or hyperactivity or both--predict subsequent depression and suicidal thoughts, distinct forms of the disease at age 4 to 6 were moderately predictive for specific problems later on. Children with inattention or combined subtype were at greater risk for depression. Those with combined type or hyperactivity were at greater risk for suicidal thoughts.

Far more boys that girls suffer from ADHD, but being female increased the risk of depression. Children whose mothers suffered from depression were also at increased risk.

Children with more complicated ADHD were most at risk, the authors conclude. "Greater numbers of depression, anxiety, oppositional defiant disorder, and conduct disorder symptoms at ages 4 to 6 among children with ADHD robustly predicted risk for depression during adolescence. Children with uncomplicated ADHD with few concurrent symptoms of other disorders were at low risk for depression, but children with many concurrent symptoms were at very high risk."

The National Institutes of Health funded this study Additional authors include Andrea Chronis-Tuscano, PhD, of the University of Maryland; Brooke Molina, PhD, of the University of Pittsburgh; William Pelham, PhD, of Florida International University; Brooks Applegate, PhD, of Western Michigan University; and Allison Dahlke and Meghan Overmyer of the University of Chicago.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Chicago Medical Center, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

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