Children as young as six years old are susceptible to depression.  It is estimated that nearly half of all children with ADHD will suffer from depression, anxiety, or other mood disorders.  Some statistics show up to 70 per cent of individuals with ADHD will at some point be treated for depression. That is an incredibly high figure.  Statistics also show that the third leading cause of death for adolescents aged 15-24 years is suicide, with depression on the rise.

Those are incredibly sad figures to read.  This post isn’t supposed to scare you, but rather to raise awareness for what some of our children may be going through.  There is a very high comorbidity between ADHD and Depression.  ADHD and Depression share some very similar symptoms however, it is vital that they are seen as different diagnoses as they are both treatable as such.

Often someone could get diagnosed with one or the other, but it has not been realised that the individual is suffering from both.  Many doctors are far more familiar with depression and likely to acknowledge the depression symptoms without recognising the ADHD side.  Incomplete or misdiagnosis can therefore occur, and this is very true for girls who are often seen as having depression as opposed to ADHD.

Symptoms of ADHD and Depression

Let us look at the symptoms of both ADHD and Depression to see why a misdiagnosis might occur.

Whilst there are indeed differences in a few of the above observable symptoms, you can see how there are many overlaps and why one diagnosis could be missed.  Both can bring changes to an individual’s mood, their ability to focus and stay focussed on a task, and their motivation.  However, it is the reasoning behind it that makes some of the differences.  For example, a child with ADHD may not be able to start a task as they are overwhelmed and confused by what task to start first and may need the task broken down into individual sections before they can commence.  Someone who is depressed may lack motivation due to exhaustion and a lack of desire to start anything.  Both just appear unmotivated, yet for totally different reasons.

What is Depression?

Depression is not just feeling sad or unhappy for a few days.  It is a real and debilitating health condition that lasts for long periods of time and affects your day-to-day life.  People cannot simply ‘snap out of it’ or just ‘pull themselves together’. 

Depression can be inherited or can occur because of an event such as a death, frustration in life, divorce, pregnancy etc.  Symptoms can appear both physically and mentally and affect someone’s behaviour.

For a full article on Depression please read the Mental Health website, A-Z on Depression.

Does ADHD cause Depression?

ADHD does put you at a higher risk of experiencing Depression.  Imagine all the daily negatives your child with ADHD hears just in school, ‘Stop fidgeting!’ (They can’t), ‘Stop shouting out!’ (They can’t), ‘Pay attention!’ (They can’t).  Hearing this nonstop when it is a behaviour that is the norm for your child with ADHD would drag anyone down and lower their self-esteem.  Now imagine if you are yet to be diagnosed and treated.  You are seen as the stereotypical ‘naughty child’ that just needs to behave!   The sheer frustration, the strain on their executive functioning, and the negative feedback must be so disheartening daily.  For even the strongest person to hear, let alone our young children and teens with ADHD!

As we know, our children with ADHD also have real physical differences in their brains and one such difference is lower dopamine levels.  Dopamine is the neurochemical responsible for motivation, pleasure, mood, and reward.  Although low dopamine doesn’t cause depression it is heavily linked to it, putting our children with ADHD at a higher risk from the start.

ADHD is also connected to RSD (Rejection Sensitive Dysphoria) which is not classed as a diagnosis but more a way of describing how highly sensitive our children can be to rejection and criticism.  So now imagine hearing negative feedback during your day, coupled with experiencing these negative emotions even more intensely and you have the ‘perfect’ individual to suffer from Depression.

What does Depression look like in children with ADHD?

These symptoms would look the same in any child at this age.

• Feeling down
• Becoming irritated or angry very quickly over anything
• Lethargic
• Avoiding school and homework
• Distancing themselves from friends
• Stopping activities, they normally enjoy
• Changes to their normal sleeping habits
• Over or undereating
• Becoming despondent, seeing no point in anything, mentions suicide

Depression in children with ADHD may also intensify their ADHD symptoms i.e., they become more easily distracted, or disorganised than usual, quicker, and have more defiant tempers.

Then of course there are the teen years when puberty causes hormones to be all over the place.  Teens with ADHD can feel very low if they experience what they see as an academic failure compared to their peers.  This is also an age when your peers are so important, and rejection can cause major issues.  They are more likely at this age to participate in risky behaviours such as alcohol or even substance abuse, also linked to feelings of depression.  I know currently in secondary schools vapes are a huge issue due to being widely available and relatively cheap.

It becomes a very difficult time.

Getting diagnosed

Finding an experienced Paediatrician or Specialist is essential.  Alas, I don’t have a list of these.  Maybe that could be something parents or carers could send me so I can compile a list?  This is so important because too many people are misdiagnosed with one or the other and not both.  Make sure when you go to your appointment that you list everything you have observed over the last few weeks or months.  If you think it is more than ADHD or Depression, speak up.  You are the one witnessing your child’s behaviour.

How to Treat ADHD and Depression

If your child has ADHD and Depression, it is recommended that your treat the one that causes the most problems first.   Lenard Adler MD, Director of Adult ADHD in NY states, ‘Work first on the condition that causes greater impairment.  Problems raised by ADHD are real, but depression can be life-threatening.’ 

ADHD and Depression are, as previously stated, two individual diagnoses.  After researching this topic, it seems most anti-depressant tablets work well with ADHD medication, if you are going down the medication route.  It is worth noting that anti-depressant medication takes between 8-10 weeks to take full effect whilst stimulant medication for ADHD symptoms is much faster.  Ironically, a side-effect of taking certain anti-depressants can be increased thoughts of suicide as the medication adjusts, so it is essential that your child is watched closely and keep your levels of communication wide open. 

Lifestyle changes can help ease symptoms of depression, these include:

• Spending time outdoors
• Exercise, raises dopamine levels and helps aid better sleep
• Meditating and mindfulness
• Keeping busy, in a good way – not in a stressful one!
• Reducing carbohydrate intake and junk food
• Cognitive Behavioural Therapy (CBT)

Keeping your child with ADHD busy is essential, but not to the point of stress!  As we know our children with ADHD hate to be bored and need interesting and challenging days.  Having things planned is great and keeping a box of fidget toys for any dull moments is essential.  I used to put some toys away each week and rotate them every few weeks so that they got the excitement back, rather than just have loads of toys out that overwhelmed them.

CBT helps to reverse the negative spiral of thinking that comes with depression.  Instead of thinking damaging thoughts and feeling hopeless, it helps to reframe thoughts from another, more positive perspective.  Finding a therapist who is familiar with ADHD and Depression would obviously be amazing.  CBT combined with anti-depressant medication is thought to give the best results.

And Finally

Build up your child’s self-esteem.  Please read ADHD and Low Self-Esteem for some ideas.

And most importantly, talk to your child.  If you notice any of these changes in them, please start talking, regardless of their age, just make it age-appropriate.  I love THE BLOB TREE and COMIC STRIP CONVERSATIONS for younger children. 

Comic Strip conversations (developed by Carol Gray) are a really good way to break down conversations and talk about feelings so that your child does not feel the attention and focus is directly on them.  You draw the child and a rough situation and then ask the child what you think that person is feeling, how would you feel etc.  Speech or thought bubbles can be used.  They recommend trying some different social situations first, not going straight in with one on depression, so the child can see how they can be used for all sorts of incidents e.g., winning a game, going on a plane etc.  Click the links in blue for the websites.

For older children, I would always recommend a car journey or a walk to avoid that awkward eye contact.  It also ensures that there are no other distractions such as other siblings, phones or tv around.  Asking a question and truly listening without judgement and giving them the time and silence to respond is essential.  No listening to reply. Just listening to listen.  Depression is very real and very debilitating.  It should not be underestimated.  People don’t enjoy feeling depressed.  Regardless of whether you think they should be depressed or not.  Any, ‘what have you got to be depressed about?’ will not help the matter and certainly won’t allow your child to open up to them in the future.  Keeping all lines of communication open is vital.