The Link Between ADHD and Depression in Teens
Raising a child or teen with ADHD/ADD can seem quite overwhelming, but when these conditions are combined with a co-occurring mood disorder this can truly be a challenging situation for any parent. This, however, is a very real challenge for over half of the families of children with an ADHD diagnosis. Research studies show that as many as 60% of children and teens diagnosed with ADHD have one or more additional co-occurring mental health conditions, such as anxiety and/or depression.
Recognizing when a child with ADHD also has depression or anxiety can be difficult. Many symptoms overlap between the conditions, including irritability, trouble concentrating, restlessness, and sleep issues. However, some signs more specifically indicate the possibility of depression, such as prolonged sadness, loss of interest in fun activities, reduced energy, feelings of worthlessness, or suicidal ideation. Anxiety may manifest as excessive worrying, panic attacks, avoidance behaviors, or frequent physical symptoms like stomachaches. Pay close attention to changes in mood and behavior that seem disproportionate to your child's situation. Also note any major shifts from previous functioning or personality at home and school.
The first challenge for any parent is to recognize the possibility that a co-occurring disorder is present. This is no easy task. Indeed, it will take the specialized skills of a qualified mental health professional familiar with both ADHD and anxiety / depression, to make the final determination. A pediatrician or educator familiar with ADHD will typically not have the specialized skills required to identify coexisting disorders and to know how to effectively treat them. If you suspect that your child is having challenges above and beyond those associated with ADHD, then it is wise to seek out a specialist familiar with the co-mingling of these disorders. Our clinic offers a free online ADHD assessment to screen for potential symptoms of child ADHD, this online screening test takes just 3 minutes to complete.
The diagnosis is complicated by the fact that many of the symptoms associated with ADHD are the same as those that are associated with other conditions, such as anxiety or depression. In children, for example, depression can often manifest as irritability, which might look like one of the characteristic of ADHD. It takes a multi-faceted assessment that includes comprehensive psychological testing, interviewing multiple respondents, careful analysis of the history of the symptoms and overall development of the child, along with clinical observations, to make a proper diagnosis.
Customizing Treatment Plans for Kids with ADHD and Depression Overlap
As the specialist builds the treatment plan the first consideration will be to determine what is the greatest impairment to your child’s life and how it should be remediated. Every child and teen is unique. It will be up to the specialist to determine if the ADHD and the coexisting disorder are treated simultaneously or one after the other. Especially in cases of severe depression a specialist may choose to address this first to improve the overall mood of your child and to increase compliance with further treatment. Invariably, a treatment plan will include cognitive-behavioral therapy to teach your child coping skills and behavior modification therapy to reduce unwanted behaviors. It may also include family therapy, play therapy, or expressive art therapy, based on the child’s age and needs.
Properly diagnosing ADHD alongside conditions like anxiety or depression requires a thorough, multifaceted assessment. This should include detailed interviews with both the child and parents to establish a comprehensive history of symptoms over time and across settings. Validated clinical rating scales, questionnaires, and psychological testing help quantify areas of concern. The specialist will compile observations from direct interaction with the child with reports from parents, teachers, coaches, or other adults familiar with the child’s functioning. Looking at the child’s cognitive, academic, emotional, adaptive, and social development is also important. This comprehensive data informs diagnosis and allows the specialist to design a customized treatment plan targeting the drivers behind the child’s impairments. Ongoing monitoring also helps evaluate progress.
Medication Management Challenges in Treating ADHD and Depression in Kids
When medication is recommended your specialist has a particular challenge since some of the ADHD medications are actually counter indicated for conditions such as anxiety. It may take several iterations of the medication plan before the right balance can be reached. This will require monitoring by you as a parent of your child or teen throughout the day. You can also ask one or more teachers to support you in this activity. As you do this, remember to not only check on the behavior of your child but also to ask them specifically about their feelings. Encourage them to be partners with you in figuring out what works for them.
Given the unique needs of each child, there is no universal medication approach for those with ADHD plus a co-occurring condition like anxiety or depression. Collaborating with both a psychiatrist and a therapist allows holistic management, addressing symptoms through both medication and therapeutic techniques tailored to the individual. The psychiatrist guides medication choices and dosage based on how the child responds, starting low and monitoring over weeks or months to find the most effective balance with minimal side effects. As a parent, you play a critical role by systematically tracking your child’s symptoms, emotions, behaviors, and any medication impacts across settings. Teachers can provide additional insight from the school environment. Open communication ensures optimal medication support as part of a comprehensive treatment plan.
Understanding the Link Between ADHD and Depression
The relationship between ADHD and anxiety / depression can be a bit of a chicken and an egg dilemma. While there are clear neurological reasons for the occurrence of anxiety and depression, these two conditions can also be brought on by environmental situations. Think about it. You have watched your child and teen struggle with their ADHD and the pain it has caused them. You have watched their confidence being sapped away by continued failures. These repeated experiences of failure can take a toll that can result in depression and/or anxiety. As parents, we try our best helping children build their self esteem, but it is especially important for parents of ADHD children. Healthy self-esteem is one of the best remedies against anxiety and depression.
Properly diagnosing and treating ADHD and anxiety and depression requires an integrated approach addressing all facets of a child's health. While ADHD has genetic underpinnings and related neurological factors, adverse environments also play a role in the development of co-occurring depression and anxiety. Chronic academic struggles, social difficulties, low self-esteem, and frequent criticism faced by many children with ADHD may directly precipitate or worsen anxiety or depression over time. Treatment must therefore attend to both biological vulnerability as well as building personal resilience through counseling methods. Addressing brain health through medication and lifestyle while also fostering coping strategies and self-confidence via therapy provides a dual approach. This comprehensive view targeting both neurobiology and environment will give children with ADHD the best tools to manage symptoms and safeguard mental wellbeing into the future. It is key that intervention considers all contributing streams to these complex disorders.
Managing Anxiety in Educational Settings for Kids with ADHD
Anxiety in particular can be conditioned by the testing process accompanying most educational environments. When a child or teen knows that even though they have studied twice as hard as anyone else they are likely to make critical mistakes during testing due to a lack of attention to detail or an inability to focus, they are likely to develop anxiety prior to testing. The fear of impending doom will be compounded with the inattentiveness that accompanies ADHD to make matters even worse.
Strategies and accommodations that can help students manage anxiety in the classroom include:
- Allowing flexible seating options (e.g. standing desks, exercise balls, wiggle seats)
- Providing fidget toys or objects to occupy hands
- Building in frequent movement breaks
- Teaching anxiety reduction techniques like mindful breathing
- Allowing headphones or music to block distractions
- Reducing stimulus overload on tests with quiet setting
- Extending time limits on assessments
- Creating alternative assessment options (projects vs tests)
- Avoiding pulling students out of preferred activities unexpectedly
- Allowing late start or half days if anxiety prevents morning focus
- Developing Individualized Education Plans (IEPs) or 504 Plans
Enlisting support professionals like counselors, therapists, special education staff builds a team approach. Support at home that includes positive reinforcement alongside skills training can also help manage anxiety rooted in the school experience.
Addressing Depression and Social Challenges in Children with ADHD
Depression can result from continued rejection by peers and continued failure to live up to the expectations that everyone seems to have for them. The isolation that often accompanies ADHD can contribute to a loss of self-esteem and a sense of hopelessness. The child or teen experiencing this kind of ADHD and depression in children may withdraw and simply stop trying to improve themselves.
This means that even if ADHD is treated by medications and instruction in organizational skills, the anxiety and depression may still remain as a result of a life history of disappointment. This is very important for a parent to be aware of. Medication alone will not be sufficient to help your child change the negative mindset resulted from years of discouragement.
Whether your child’s ADHD, depression, and anxiety are the result of a neurobiological condition, social conditioning, or a combination of both really does not change how you will work with him or her to overcome these challenges. In addition to the support of a counselor or therapist who fully understands what your child is experiencing you will need to be actively engaged in providing a supportive environment.
Strategies for parents and educators to facilitate positive social experiences for children with ADHD include:
- Teaching peers about neurodiversity and compassion for differences
- Organizing small friend groups rather than large teams
- Practicing conversation skills through role play
- Creating a buddy system for group activities
- Encouraging interests/hobbies aligned with child's strengths
- Monitoring play dates and interactions for bullying
- Speaking positively about child to other parents
- Explaining appropriate behaviors vs. ADHD symptoms
- Arranging video calls instead of phone calls
- Accompanying child to social events as needed
- Enforcing rules firmly, fairly and consistently
- Advocating for child’s needs with coaches and activity leaders
- Celebrating friendships and peer support
Focusing on strengths, teaching social skills directly, and cultivating communities where children with ADHD feel secure and accepted for who they are all enable success.
The Role of Positive Reinforcement in ADHD and Depression
One of the most powerful tools you have at hand is your ability to praise your child. Given that their lives are primarily filled with criticism and rejection finding ways to compliment your child on a job well done can become incredibly important. There are several skills that you as a parent will need to develop to do this effectively. First, spend some time thinking about your child or teen’s strengths. What is it that they do well? Are they funny? Are they kind to a brother or sister? Do they have a passion for a particular subject or activity such as a sport or a hobby? Too often parents in their desperation to improve behavior in their ADHD boy or girl will use favorite activities as barter chips to negotiate for better behavior. But this can only increase depression and anxiety. Instead, whenever you see your child engaged in something that they love and are doing well, take the time to compliment them. Point out their strengths as a way to build up their damaged self-esteem.
Effective ways parents can utilize positive reinforcement include:
- Praising small wins and efforts rather than just outcomes
- Using encouragement to motivate instead of criticism
- Noting positive behaviors unprompted
- Displaying work/art proudly around home
- High-fiving or flashing a thumbs up for tasks completed
- Scheduling consistent special one-on-one fun time
- Letting child pursue preferred hobbies without pressure
- Tracking and celebrating incremental progress
- Avoiding rescue from consequences to build self-efficacy
Focusing on positives cultivates self-confidence to counteract the frequent criticisms children with ADHD face.
Setting Realistic Expectations for Kids with ADHD and Depression
Second, consider your expectations of them and the tasks that you give them. Remember that the ADHD brain is typically 3 to 5 years developmentally behind the brain of chronological peers. When you set tasks and expectations for your child remember to scale them accordingly. If you find that a task that you have assigned your child around the house, such as being responsible for taking out the garbage or doing their own laundry, repeatedly results in failure, then consider finding a way to break these tasks into smaller pieces with a larger chance of success. Especially for a child with a depressed mood it is important to experience success. For example, for the teen who can’t remember to do their own laundry you might begin by doing the laundry and then putting the unfolded clothes on their bed. This too may result in failure but it will have a stronger likelihood of success than asking them to take ownership of the entire laundry function.
Strategies for setting up children with ADHD for success include:
- Breaking tasks down into very small, manageable steps
- Using timers, alarms and reminders for key task components
- Rotating high-interest tasks with boring tasks
- Allowing movement and sensory breaks between tasks
- Offering rewards tied to effort, not just task completion
- Ensuring needed supports are available (checklists etc)
- Alternating solo work with partner or team work
- Starting with very short work sessions (5-10 mins)
- Permitting accommodations without flagging as “special treatment”
Continually try to put your child in situations where they can be successful. Build on their strengths and praise them for what they do well and minimize the negative speech associated with their shortcomings. This means avoiding putting your child in situations where there is a high likelihood that they will in some way embarrass themselves. Your job, as difficult as it may be, is to continually reinforce your child’s sense of their own value and worth as a unique individual deserving your love - as indeed they are.
In Summary
Treating ADHD alongside commonly co-occurring conditions like anxiety and depression in children and teens requires a nuanced, multi-faceted approach. Careful assessment and diagnosis by a specialist familiar with both ADHD and mental health is a crucial first step. Once treatment plans are in place, managing medications and therapies tailored to the individual's needs is key, with parents and educators playing a critical supportive role. Progress monitoring and open communication ensures treatment is adjusted as necessary over time for the best outcomes. With comprehensive understanding and management of ADHD and its many complexities, children and families are empowered to advocate for their needs, achieve personal growth, and enjoy happiness and success for years to come. It truly takes a village of caring professionals, school staff, parents, and other allies working together to help young people thrive.
References:
- National Institute of Mental Health. Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need to Know. 2023.
- ADHD and Co-occurring Conditions. 2023.
- ADHD and Co-occurring Conditions - Infographic. 2023.
- Data and Statistics on Children's Mental Health. 2023.
- Medical News Today. The best medications for depression, anxiety, and ADHD. 2023.
- National Institute of Mental Health. Children and Mental Health: Is This Just a Stage? 2023.
