ADHD Children and Depression

Written by David Rabiner, Ph.D.

Several well conducted studies have shown that children with ADHD are more likely than others to become depressed at some time during their development. In fact, the risk for developing depression is as much as 3 times greater than for other children.

A study published in the Journal of Affective Disorders (January 1998, 113-122) examined the course of depression in 76 children with ADHD in order to learn more about the relationship between ADHD and depression. The authors were especially interested in whether depression in children with ADHD represents an actual clinical depression, or whether it may be better understood as a kind of "demoralization" that can result from the day-to-day struggles that children with ADHD often have.

Depression Defined

Lets begin by reviewing what mental health professionals mean when they talk about depression. The important point to emphasize is that the clinical diagnosis of depression requires the presence of a collection of different symptoms - just because one is feeling down or depressed does not necessarily mean that the diagnosis of major depression would be appropriate.

According to DSM-IV, the publication of the American Psychiatric Association that lists the official diagnostic criteria for all psychiatric disorders, the symptoms of major depression are as follows:

• depressed mood most of the day nearly every day (in children and teens this can be irritable mood rather than depressed);
• loss of interest or pleasure in all, or almost all, activities;
• significant weight loss when not dieting or weight gain, or a decrease or increase in appetite
• insomnia or hypersomnia (i.e., sleeping too much) nearly every day;
• extreme restlessness or lethargy (e.g., very slow moving;
• fatigue or loss of energy nearly every day;
• feelings of worthlessness or inappropriate guilt;
• diminished ability to think or concentrate nearly every day;
• recurrent thoughts of death and/or suicidal thoughts;

For the diagnosis of depression to apply, 5 or more of the symptoms listed above need to be present during the same 2 week period (i.e. the symptoms must have persisted for at least 2 weeks), and at least one of the symptoms must be either 1) depressed mood (irritable mood in children can qualify) or 2) loss of interest or pleasure.

In addition, it must be determined that the symptoms cause clinically significant distress or impairment, are not due to the direct physiological effects of a medication or general medical condition, and are not better accounted for by bereavement (i.e., loss of a loved one).

As you can see, the important point is that true clinical depression is indicated by a collection of symptoms that persist for a sustained time period, and is clearly more involved that feeling "sad" or "blue" by itself.

Is Depression in Children the Same as in Adults?

Let me also say a few words about depression in children. Research has shown that the core symptoms for depression in children and adolescents are the same as for adults. Certain symptoms appear to be more prominent at different ages, however. As already noted above, in children and teens the predominant mood may be extreme irritability rather than "depressed". In addition, somatic complaints and social withdrawal are especially common in children, and hypersomina (i.e., sleeping too much) and psychomotor retardation (i.e., being extremely slow moving are less common).

What, then, would a "typical" depressed child look like? Although there, of course, would be wide variations from child to child, such a child might seem to be extremely irritable, and this would represent a distinct change from their typical state. They might stop participating or getting excited about things they used to enjoy and display a distinct change in eating patterns. You would notice them as being less energetic, they might complain about being unable to sleep well, and they might start referring to themselves in critical and disparaging ways. It is also quite common for school grades to suffer as their concentration is impaired, as does their energy to devoted to any task. As noted above, this pattern of behavior would persist for at least several weeks, and would appear as a real change in how the child typically is.