David Rabiner, Ph.D. Research
Professor, Duke University
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David Rabiner, Ph.D.
(Note: If you are looking for information on Attention Deficit Disorder (ADD) please be aware that much of what is discussed below should also be relevant. Technically, the term ADD is no longer used. Instead, children who have the inattentive symptoms of ADHD but who do not show hyperactive/impulsive symptoms are now diagnosed with ADHD, Predominantly Inattentive Type rather than with ADD. These terms mean pretty much the same thing but the latter is no longer technically correct.)
ADHD/ADD and Depression
Several well conducted have shown that children with
Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder are more
likely than others to become depressed at some time during their development.
In fact, their risk for developing depression is as much as 3 times greater
than for other children.
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
* 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
* 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
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
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
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 hypersomnia
(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/or
very sad, and this would represent a distinct
change from their typical state. They might
As noted above, children with ADHD/ADD appear to be at increased risk for the development of depression. In addition, it is important to recognize that in some children, the symptoms of depression can be incorrectly diagnosed as reflecting ADHD/ADD. That is because diminished concentration, failing to complete tasks, and even agitated behavior that can resemble hyperactive symptoms can often be found in children who are depressed. It is thus quite important to be certain that depression has been ruled out as an explanation for the symptoms of ADHD/ADD a child may be displaying. Having said this, please remember that for many children, Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder and depression can co-occur - i.e. be present at the same time. Thus, it is not always a matter of ruling out depression to diagnose ADHD/ADD, or ruling out ADHD/ADD and diagnosing depression. This is because in some situations both diagnoses would be appropriate and is one of the reasons why a careful evaluation by a trained child mental health professional can be so important to have done.
Recent research has suggested that in children with ADHD/ADD who are depressed, the depression is not simply the result of demoralization that can result from the day to day struggles that having ADHD/ADD can cause. Instead, although such struggles may be an important risk factor that makes the development of depression in children with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder more likely, depression in children with ADHD/ADD is often a distinct disorder and not merely "demoralization".
The results of one recent study indicated
that the strongest predictor of persistent major depression in children with
ADHD/ADD was interpersonal difficulties (i.e. being unable to get along well
with peers). In contrast, school difficulty and severity of Attention Deficit
Hyperactivity Disorder/Attention Deficit Disorder symptoms were not associated
with persistent major depression. In addition, the marked diminishment of
ADHD/ADD symptoms did not necessarily predict a corresponding remission of
depressive symptoms. In other words, the course of ADHD/ADD symptoms and
the course of depressive symptoms in this sample of children appeared to
be relatively distinct.
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 currently
more compelling than the evidence supporting
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/ADD. In addition, if a child with ADHD/ADD 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 Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder 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.
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