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Recent research has indicated that 2/3 of children with children with ADHD, which is actually a neurological problem, also have a mental health diagnosis. It is not surprising that given the academic and social stresses faced by children and teens with ADHD, they are specifically at increased risk for the development of depression. Making matters more complicated, it is also important to recognize that in some children, the symptoms of depression can be incorrectly diagnosed as reflecting ADHD. The bottom line is that when a child with ADHD also has depression it can become messy to sort out what exactly is actually going on.
More specifically, problematic concentration in class, failing to complete tasks, memory problems (like forgetting to turn in homework that is completed, ugh!) and even agitated behavior can resemble ADHD symptoms and are often be found in children who are depressed. These symptoms can be demoralizing for children and teens. It becomes hard to distinguish between the "cannots" from the "choose nots" when children have ADHD and even harder when you factor in depression. A thorough evaluation by a qualified mental health professional can help rule out depression as an explanation for the symptoms of ADHD that a child may be displaying.
Many children and teens with ADHD lack the emotional intelligence skills to be truly self aware of their frustration, anger, shame, and depressed feelings they experience from school related problems. Even if they are in touch with these negative feelings, they tend to lose them when swimming in that big river in Egypt--- "De Nile (Denial)." For example, in my practice with ADHD children and teens who also struggle depression, it is common that explanations for their hardships end up denying their own responsibility, e.g., "My teacher is a jerk." Often, children and teens are not able to process and express these negative feelings. They lack this ability to constructively express themselves and to seek support. This leaves them on the "bottle it up and explode/act out later plan." We all know how non productive that is!
It is also likely that the combustible mixture of ADHD with depression may also result from the social/interpersonal difficulties that many children with ADHD experience. For example, children and teens with ADHD tend to interrupt others. They also may misread social cues and intrude, rather than ease into, games and other activities that their peers are engaged in. This could lead others to negatively react to them. With increasing age, these negative social experiences and others' negative opinions can limit these childrens' view of their social competence. This may lead to them developing depressive symptoms such as sadness, poor sleep or eating, tearfulness, agitation, social withdrawal, isolation/immersion in videogames, and other avoidance behaviors,
If a child with ADHD does develop depression, treatments that target the depressive symptoms specifically need to be implemented. 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 teens, and you really want to be dealing with someone who has extensive experience in this area. For more information about ADHD and co-occuring conditions such as depression, you may want to check out my book 10 Days to a Less Distracted Child.
For more tips on helping children and teens with a range of concerns, follow Dr. Jeff on Twitter
