Depression in ADHD and ADD children,
natural supplements to help, and books for further help and reading on
depression.
ADHD
and DEPRESSION
Several well conducted 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 recently 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.
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 ofsymptoms that persist
for a sustained time period, and is clearly more involved that
feeling "sad" or"blue" by itself.
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 achild 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.
With this brief overview of depression behind us, lets
get back to the study. The authors of this study started with 76
boys who had been diagnosed with both major depression and ADHD and followed
them over a 4 year period. Because depression can be such a debilitating-
condition they were interested in learning what factors predicted
persistent major depression, and how the course of depression and ADHD
were intertwined.
The results of the study indicated that the
strongest predictor of persistent major depression was interpersonal difficulties
(i.e being unable to get along well with peers). In contrast,
school difficulty and severity of ADHD symptoms were not associated
with persistent major depression. In addition, the marked diminishment
of ADHD symptoms did not necessarily predict a corresponding remission
of depressive symptoms. In other words, the course of ADHD symptoms and
the course of depressive symptoms in this sample of children appeared
to be relatively distinct.
The results of this study suggest thatin
children with ADHD who are depressed, the depression is not simply the
result of demoralization that can result from the day to day struggles
that having ADHD can cause. Instead, although such struggles may be an
important risk factor that makes the development of depression in children
with ADHD more likely, depression in children with ADHD is a distinct disorder
and not merely "demoralization".
Depression in children can be
effectively treated with psychological intervention. In fact,
the evidence to support the efficacy of psychological interventions for
depression in children and adolescents is more compelling than the evidence
supporting the use of medication.
The important point that can be taken from this study,
I think, is that parents need to be sensitive to recognizing the symptoms
of depression in their child, and not to simply assume that it is just
another facet of their child's ADHD. In addition, if a child with ADHD
does develop depression as well, treatments that target the depressive
symptoms specifically need to be implemented. As this study shows, one
should not assume that just addressing the difficulties caused by the ADHD
symptoms
will also alleviate a child's
depression.
If you have concerns about depression in your child, a
thorough evaluation by an experienced child mental health professional
is strongly recommended. This can be a difficult diagnosis to correctly
make in children, and you really want to be dealing with someone who has
extensive experience in this area.
Each month the top 10 books depression
and ADD or ADHD are listed here. They are the books that others are
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